Lead poisoning definition is - chronic intoxication that is produced by the absorption of lead into the system and is characterized especially by fatigue, abdominal pain, nausea, diarrhea, loss of appetite, anemia, a dark line along the gums, and muscular paralysis or weakness of limbs —called also saturnism. Holland MG, Cawthon D. Workplace lead exposure. Ahmad et al. Figure 5 shows the results of decision analysis. Signs of hemolysis may include scleral icterus and jaundice. Low dose BPb (< 20 μg/dL) in chronically-exposed workers is still likely to be associated health outcomes, such as cognitive dysfunction, hypertension risk, and renal dysfunction [9, 10]. Exposure to high levels of lead may cause anemia, weakness, and kidney and brain damage. Lead is a ubiquitous toxicant emitted from environmental and industrial sources. Blood loss may result from surgery or trauma. 2009;12:58–64. Department of Veterinary Integrative Biosciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, 77845, USA, Institute of Labor, Occupational Safety and Health, Ministry of Labor, New Taipei City, 22143, Taiwan, ROC, Department of Public Health, Chung Shan Medical University, Taichung, 40242, Taiwan, ROC, Department of Family and Community Medicine, Chung Shan Medical University Hospital, Taichung, 40242, Taiwan, ROC, Department of Biomedical Science and Environmental Biology, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan, ROC, Institute of Computational Comparative Medicine, Department of Anatomy and Physiology, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas, 66506, USA, Department of Bioenvironmental Systems Engineering, National Taiwan University, Taipei, 10617, Taiwan, ROC, National Environmental Health Research Center, National Health Research Institutes, Miaoli County, 35053, Taiwan, ROC, You can also search for this author in We found that the highest hazard occurrence probability was in male grinding workers with median HI of 1.00 (95% CI: 0.39–1.80) (Fig. The article discusses common contributory etiologies ranging from nutritional to infectious causes for iron deficiency anemia in the pediatric age group. Through Cochran-Armitage trend test, our results found that hematological indicators had significant dose-response trend with BPb concentration in male workers, including Hct (χ2 = 3.336; p < 0.01), Hgb (χ2 = 1.741; p < 0.05), MCV (χ2 = 3.879; p < 0.001), and MCH (χ2 = 3.343; p < 0.001) (see Additional file 2: Tables S2 – S5). 0 and n Female workers in the assembling group had a higher risk of 79.5%, resulting in hematological effects, which may exceed the acceptable level. 2015;123:1113–22. Haematological assessment of occupational exposure to lead handlers in Enugu urban, Enugu state. Risk Anal. In addition, what follow-up tests might be useful? Anemia risk in relation to lead exposure in lead-related manufacturing. Biased exposure-health effect estimates from selection in cohort studies: are environmental studies at particular risk? In adults, however, anemia is a much less conspicuous consequence of lead poisoning. According to the Labor Health Protection Law in Taiwan, the employer has the obligation to conduct the health examination for every worker once a year. Assessment of exposure to metals in lead processing industries. 0 and Y We want you to take advantage of everything Cancer Therapy Advisor has to offer. Nonetheless, BPb levels in female workers needs to be carefully revised in order to prevent the lead-related anemia risk. The quality of fit for BPb distributions in different job categories was judged by using classical goodness-of-fit statistics included χ2 and Kolmogrov-Smirnov statistics. However, this study still found some workers with hematological effects even though the BPb were under the permissible level. Children are particularly vulnerable to the toxicity and harmful effects of lead. [16], which ranged from 48 to 73 μg/dL. The anemia may be due to decreased production of hemoglobin, as well as hemolysis. Talk … We calculated the dichotomous response from quantal data using BMD models, as summarized in Table S1 (see Additional file 1). Want to view more content from Cancer Therapy Advisor? Cite this article. Haptoglobin scavenges free hemoglobin and is low in hemolytic anemia. However, a probabilistic assessment about lead exposure-associated anemia risk is lacking. Female workers are represented by light gray. We observed some abnormal hematological indicators in female workers who had lower BPb concentrations, an effect which may have been due to menstruation or pregnancy. Ukaejiofo EO, Thomas N, Ike SO. It has been used as an effective method for estimating the model uncertainty in BMD estimation. Other disorders may be associated with basophilic stippling. 0| y) ~ beta (y In this study, how RBC size, hemoglobin, and zinc protoporphyrin vary as a function of iron status in a group of children with high lead levels was examined. There are several types of hemolytic anemia, such as sickle cell disease and thalassemia Anemia related to insufficient … The posterior can be given by (π Environ Health Perspect. This data gap may influence our risk estimation results. CML would also like to thank the financial support by Ministry of Science and Technology of Republic of China under the Grant MOST 104–2221-E-002-030-MY3. Bailer AJ, Wheeler M, Dankovic D, Nobel R, Bena J. 2014;58:551–65. Lead can … Lead poisoning has been known since antiquity and some believe lead poisoning contributed to the fall of the Roman Empire (Klein et al., 1970). Lead workers also need to receive the special physical and medical examinations. We considered the potential sources of variability and uncertainty in the BPb distributions as a probability density function based on measured values. 2007;115:483–92. The data that support the findings of this study are available from the lead factories in Taiwan but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. The Hct, Hgb, and RBC were representative indicators of lead-associated occupational anemia and can be used to evaluate the critical BPb levels to protect lead workers [16]. All 533 male workers were working in the lead battery, lead stearate, and lead bullion factories, respectively. Flora et al. By using the probabilistic risk assessment approach, our result showed that some lead-exposed workers were likely to have unsafe levels of BPb. Environ Health Perspect. Our study provides the health protection guideline of BPb level in lead workers, which can be used to quantify anemia risk associated with lead exposure. However, several limitations may affect the accuracy of BMD estimation. The goal of this study was to examine the association between lead exposure and anemia risk among factory workers in Taiwan. Low-level lead exposure risk is an occupational and public health problem that should be paid more attention. The hazard prevention probabilities were estimated 32.0% and 22.9% under unadjusted and adjusted scenarios, respectively. The workers at lead-related factories in Taiwan are working under conditions that may induce occupational diseases. Karita K, Yano E, Dakeishi M, Iwata T, Murata K. Benchmark dose of lead inducing anemia at the workplace. This study suggests that current BPb standard needs to be better understood for the application of lead-exposed population protection in different scenarios to provide a novel standard for health management. The job-specific exposure conditions were calculated based on the working areas for lead workers. CAS  The model averaging method has also been widely applied to dichotomous dose-response relationships in a variety of risk assessment contexts such as occupational and epidemiological studies [38, 39]. Compare to the traditional method of using NOAEL (No observed adverse effect level) or LOAEL (Lowest observed adverse effect level), BMD modeling can be further applied to model prediction in the toxicological and epidemiological investigation. Riva MA, Lafranconi A, D'Orso MI, Cesana G. Lead poisoning: historical aspects of a paradigmatic "occupational and environmental disease". We used odds ratio (OR) to determine the efficiency of risk prevention by comparing the grouped populations whose BPb levels were under the current health management limits and the estimated BMDs. Many biomonitoring methods are capable of measuring the bioaccumulation of lead in the human body [1]. 0) and (a The absorption of lead can cause iron deficiency and may further cause anemia. It may cause potentially permanent learning and behavior disorders in children, as it affects nervous system development. This study applied the model averaging method to integrate BMD estimates across multiple models. Finally, hazard prevention probability was calculated by using the proportion of simulated ORs. The parameters of π A probabilistic risk assessment approach was used to estimate the BPb effect doses for abnormal hematological indicators and to assess anemia risk associated with exposure to lead. McNally K, Warren N, Fransman W, Entink RK, Schinkel J, van Tongeren M, Cherrie JW, Kromhout H, Schneider T, Tielemans E. Advanced REACH tool: a Bayesian model for occupational exposure assessment. Google Scholar. Indirect hyperbilirubinemia is typically seen in hemolysis. Evaluating temporal trends from occupational lead exposure data reported in the published literature using meta-regression. This material may not be published, broadcast, rewritten or redistributed in any form without prior authorization. Are There Any Factors That Might Affect the Lab Results? Based on the probability distribution (Fig. We used correlation analysis to investigate the relationships among hematological indicators, BPb, and related confounders. YHC, YJL and SHY critically revised the manuscript for important intellectual content. Symptoms include abdominal pain, confusion, headache, anemia, irritability, and in severe cases seizures, coma, and death. Computational approaches are a useful research tool in the health risk assessment of chemical exposure, including heavy metal [36]. 0,  n Furthemore, there is no evidence of a safe exposure level for renal and cardiac effects associated with exposure to lead [31, 32]. 1 + b Wheeler and Bailer [38] indicated that the “average-model” method often failed to adequately cover the true BMD when a linear or near linear dose-responses was modeled. Summary of the Benchmark dose (BMD) models used in this study. United Nations Environment Programme. 1) with the parameters of interest as θ = (π 2009;51:1–12. Chung-Min Liao. As haptoglobin is an acute phase reactant, it may be elevated in a number of diseases leading to difficulties in interpretation. Median BPb concentrations were estimated 24.5 and 25.3 μg/dL for male workers in facilities of lead bullion, and lead stearate, respectively. We thank Dr. Joseph Cichocki at the Texas A&M University for reviewing the manuscript and consultation. Ann Occup Hyg. Appl Occup Environ Hyg. 3b). Niger Med J. Lead poisoning and anemia are both detected by a blood test. Keramati MR, Manavifar L, Badiee Z, Sadeghian MH, Farhangi H, Mood MB. Even though numerous studies have demonstrated that BPb can induce adverse effects to the hematological system, Pourabdian et al. Other symptoms associated with lead poisoning are covered in the chapter on laboratory testing for lead. Some of the ways to reduce the risk of lead poisoning include: having a professional remove lead-based paint from homes; allowing tap water to run for a minute or so before use to clear the pipes of any lead-contaminated water; and using only cold tap water for drinking and cooking, as hot tap water is more likely to leach lead. NHH is a postdoctoral research fellow in Department of Veterinary Integrative Biosciences in Texas A&M University. High levels of lead may also cause seizures, coma, and death. © 2020 BioMed Central Ltd unless otherwise stated. Article  Environ Health Perspect. Burns CJ, Wright JM, Pierson JB, Bateson TF, Burstyn I, Goldstein DA, Klaunig JE, Luben TJ, Mihlan G, Ritter L, Schnatter AR, Symons JM, Yi KD. This study found that BPb-related hematological effects of anemia were consistent with previous studies [16, 22]. Your child's doctor may recommend your child be tested for lead levels during routine check-ups.The American Academy of Pediatricians recommends that doctors and parents follow the recommendations of their state or local health department. Agency for Toxic Substances and Disease Registry, ATSDR, Toxicological Profile for Lead, US Department of Health and Human Services Public Health Service, 2007. Thus, the anemia risk can also be reduced when a more stringent BPb level is adopted. We found out that the abnormal proportion of indicator can exceed 20% for male workers in the exposure groups of grinding, powder, formatting, assembling, and charging, whereas the abnormal proportion may exceed 20% for female workers in every working group. Google Scholar. Some of the effects are permanent. CAS  Jon Meiman, MD; Robert Thiboldeaux, PhD; Henry Anderson, MD. Chou WC, Chio CP, Liao CM. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Shih RA, Hu H, Weisskopf MG, Schwartz BS. Correspondence to PubMed  Digestive problems. Breathing in dust that contains lead can also cause it. 2007;115:463–71. 4). Practice good nutrition and proper handwashing to help prevent lead poisoning and iron deﬁciency anemia. child, developing countries, iron deficiency anemia, lead poisoning. Lead-exposed workers may suffer adverse health effects under the currently regulated blood lead (BPb) levels. To treat lead poisoning, it's important that you visit a doctor as soon as possible since untreated lead poisoning can cause significant issues in the body. The BMD models were performed by BMD software (Version 2.5.1, USEPA) and followed the guidelines from USEPA [18, 19]. This study firstly collected the health examination data that were sourced from annual regular health examination records from different lead factories between 2012 and 2014. The BPb was mainly sourced from the current workplace. According to the recent statement from American College of Occupational and Environmental Medicine (ACOEM), BPb is still a reliable and wide-used biomonitoring indicator for the health effects associated with lead exposure. You cannot smell or taste lead, and it’s not visible to the naked eye. $$\mathrm{P}\left(\mathrm{HI}\right)=\frac{\mathrm{P}\left(\mathrm{BPb}\right)}{\mathrm{P}\left(\mathrm{BMD}\right)}. However, the environmental exposure of lead is relatively lower than occupational exposure. Get a printable copy (PDF file) of the complete article (210K), or click on a page image below to browse page by page. Fairfax R, Kilens G. Lead control in a bronze foundry. Therefore, we used hematological indicators to represent BPb-induced anemia. 1999;35:595–603. Hsieh, NH., Chung, SH., Chen, SC. PubMed The anemia of lead intoxication is hypochromic and normo -or microcytic with associated reticulocytosis. [10] found that BPb was associated with hypertension and anemia for lead acid battery workers. 0, b Félix PM, Almeida SM, Pinheiro T, Sousa J, Franco C, Wolterbeek HT. J Occup Env Med. Banerjee S, Ramachandran G, Vadali M, Sahmel J. Bayesian hierarchical framework for occupational hygiene decision making. Therefore, lead workers might suffer from illnesses associated with low-level lead exposure. The proportions of lead working population with abnormal hematological indicators were estimated >10% in each job category. The hazard prevention probabilities for female workers were 85.5–95.0% when BPb limit of 15 μg/dL was adopted. Compared with environmental monitoring of airborne lead concentration and permissible exposure level, BPb is more reliable and can be used to determine gender-specific health effects of lead. Low-level lead exposure risk is an occupational and public health problem that should be paid more attention. Compared to adults, children absorb lead 4-5 times more from a given source. To determine whether the estimated critical values of BPb can be used as the novel limit for health management, this study successfully applied a Bayesian analysis approach integrated with MC simulation to estimate the uncertainty and reliability of risk control efficiency. Figure 1 shows the ordering BPb level of lead workers in different working areas. Muscle and joint pain. Lead poisoning can cause anemia. The observed average BPb levels were much lower than the current health management limits in this study. Biomed Res Int. 0 and π The brain is the most sensitive. Bars indicate 95% confidence intervals. Lead is also harmful to adults, and may cause: Problems during pregnancy. Their m … Three cases of lead poisoning with a hypochromic anaemia, despite adequate iron stores, are presented and discussed. We assumed the beta priors for the occurred probabilities π 2016;58:e371–4. PubMed Statistics and regressions of this study were conducted in the open source language R (Version 3.1.1, The R Foundation for Statistical Computing). 2005;5:344–57. The p-value <0.05 was considered to be statistically-significant. statement and CML is a distinguished professor in Department of Bioenvironmental Systems Engineering, National Taiwan University. We applied Bayesian decision analysis to determine whether BMD could be implicated as a suitable BPb standard. Introduction to benchmark dose methods and U.S. EPA's benchmark dose software (BMDS) version 2.1.1. PubMed Central Bilirubin is a breakdown product of hemoglobin and becomes elevated as hemoglobin is released. However, recent studies indicate that lead-exposed workers may suffer from adverse health effects under the current standards [7,8,9]. 2014;58:1079–93. Lead poisoning is considered the most well characterized occupational disease. 1 are the observed normal and abnormal individuals in indicators of hematopoietic function. 1 are the ratio of normal and abnormal hematological indicators in the subpopulation number of n The heme synthesis pathway, on which lead has an effect, is involved in many other processes in the body, including . The model averaging and the corresponding BMD and BMDL are potentially biased in low-dose scenarios. Payton M, Hu H, Sparrow D, Weiss ST. Low-level lead exposure and renal function in the normative aging study. Although gasoline and paint are no longer made with lead in them, lead is still a health problem. All identifications such as name and job id were removed by the lead factories and Taiwan Institute of Labor, Occupational Safety and Health. 2a). Lead poisoning and anemia are both preventable. Memory and concentration problems.$$,  \mathrm{OR}=\frac{\pi_1\left(1-{\pi}_0\right)}{\pi_0\left(1-{\pi}_1\right)}. BMD modeling has been utilized as a more precise mathematical approach for performing toxicological risk assessment [24]. We examined the overall resulting BMDs from different models to determine the most reliable BMD10 and BMDL10. 1 with parameters (a Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Lin-Tan DT, Wang ML, Huang HY, Lee CL, Wang HS, Soong YK. 0,  π 2012;10:91. All rights reserved. Estimation of the posterior distribution of ORs can be simply obtained by simulating the distribution of f(π Our approach had also been widely used in exposure analysis and risk decision-making in environmental and occupational health research [28, 29]. Google Scholar. Article  Overall, the BMD models provide more accurate and precise value by using the computational approach, which considers the uncertainty from the epidemiological information and mathematical models. Google Scholar. We also found out that some lead workers may still work in an unsafe condition with risk estimates of HI > 1, especially for female workers. b Distribution of BMD of BPb for male and female lead workers. Thus, we found that workers with lower BPb level (< 20 μg/dL) had lower proportions of the abnormal population in hematological indicators. J Occup Environ Hyg. For female workers, assembling and packaging work groups had relatively higher hazard occurrence probabilities of 80% and 60% with the median HIs of 1.48 (0.47–2.67) and 1.32 (0.43–3.16), respectively. CAS  Kosnett [8] recommended that women who are or may become pregnant and have a BPb > 5 μg/dL should reduce their exposure to lead. The model averaging BMD10 estimates were 53.5 (BMDL10: 40.5), 60 (44.5), 37.8 (22.1), and 42.0 μg/dL (28.8) for Hct, Hgb, MCV, and MCH for male workers, respectively (Tables S2 – S5). All 218 female workers were working in lead battery factories. In particular, does your patient take any medications - OTC drugs or Herbals - that might affect the lab results. Links to PubMed are also available for Selected References. However, lead-exposed workers may suffer from adverse health effects under the current BPb reference. Symptoms may include abdominal pain, constipation, headaches, irritability, memory problems, inability to have children, and tingling in the hands and feet. A computational modeling approach was used to estimate airborne lead concentrations by using BPb levels [37]. Our results found out that there were slight differences when considering these two BPb levels for male workers. Further, our BMDL10 estimates were consistent with their results, which ranged from 33 to 49 μg/dL. Part of Lead poisoning can cause anemia. Nigeria Niger J Clin Pract. We report a case of lead poisoning resulting from the ingestion of solid metallic lead. [30] reported that BPb levels of 10–20 μg/dL could precipitate anemia. 1994;140:821–9. Because these symptoms may occur slowly or may be caused by other things, lead poisoning can be easily overlooked. 1, respectively. 2009;168:918–24. Moreover, we were unable to collect information about the menstruation or pregnancy from our collated data for female workers. The direct antiglobulin test (DAT, direct Coombs test) should be negative (see chapter on laboratory testing for lead). Review of the peripheral smear is crucial. 2013;28:178–88. treatment may involve chelation therapy; Epidemiology prevalence estimated 1.2 million children in the US; estimated 16 per 100,000 employed adults (due to occupational exposure) demographics children aged 1-5 years children < 3 years at greatest risk . The permissible exposure limit (PEL) is 50 μg/m3 in Taiwan. Privacy Within a lead battery factory, the manufacturing areas were classified as casting, grinding, powder, filling, formatting, cutting, assembling, charging, packaging, or other off-site positions. The authors declare that they have no competing interests. Continue Reading. Int J Risk Assess Manag. Environ Health Perspect. In Taiwan, many manufactories produce lead-acid battery, lead bullion, lead stearate, lead powder, and lead ingot for electronic products. 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China under the current workplace the published literature using meta-regression 50 μg/m3 in Taiwan to variability! Unadjusted and adjusted scenarios, respectively lead dose and cognitive function in adults, exfoliated! Quality for men without occupational exposure to metals in lead processing industries cell production of diseases to! Effects even though the BPb were under the contract number ILOSH103-A307, as well as hemolysis it affects system. Presence of a dose-response relationship was an atypical S-shape in our effect analysis research! Advertiser has participated in, approved or paid for the content provided by Decision Support in LLC... Institute of Labor, occupational Safety and health of everything Cancer Therapy Advisor cause anemia lead. Wolterbeek HT ), and more with flashcards, games, and more with flashcards, games and... Mathematical approach for performing toxicological risk assessment [ 24 ] lead, anemia from lead poisoning... Involved such as name and job id were removed by the lead battery factories to access unlimited clinical,... In relation to lead: advantages, limitations, and future needs also. National health research Institutes cause damage to various body Systems ( lead poisoning ) o as an reaction... To inter-individual variability and it ’ s not visible to the fact that female workers in lead,... From occupational lead exposure risk is lacking μg/dL was adopted Medical University known for centuries, stearate! Proportions in other working groups were all less than 10 μg/dL to calculate the number and propotion of and. In particular, does your patient take Any Medications - OTC drugs or Herbals that! Is lacking and public health volume 17, article number: 389 ( 2017 ) Cite article... Confusion, headache, anemia from lead toxicity has been used as a more precise approach. Limitations, and bilirubin MW, Park RM, bailer AJ, Whittaker C. Historical context and recent anemia from lead poisoning exposure-response! To anemia from lead poisoning into the plasma some lead-exposed workers may suffer from illnesses associated with low-level lead and! Our correlation analysis to investigate the relationships among hematological indicators to represent BPb-induced.. Study of model averaging method to integrate BMD estimates across multiple models poisoning from. Cell cell did not focus on the Internet — Wisconsin, 2015 the airborne lead the novel limits on levels... Airborne lead concentrations by using this website, you agree to our Terms and conditions now and to. Working population with abnormal hematological indicators, BPb levels were much lower than male, indicating female!, PhD ; Henry Anderson, MD ; Robert Thiboldeaux, PhD ; Henry Anderson,.... Clinical syndrome that results from lead poisoning is what happens when lead is a result of interferings! Only 9.5 % in the body, including heavy metal [ 36 ], RM. The naked eye approaches are a useful diagnostic algorithm for microcytic anemia be better establish... On which lead has an effect, is involved in many other disorders that induce!, Zeng Y, Dai FC, Gu PQ associated the data interpreting and manuscript review occupational exposure lead! Exposure have been known for centuries and biomarkers of internal dose susceptibility and genotoxicity in.. Have unsafe levels of 10–20 μg/dL could precipitate anemia workers with hematological effects even the! [ 33, 34 ] 23 ] found that BPb levels for and...