Turkish Journal of Hematology Volume: 35 - Issue: 4

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IMAGES IN HEMATOLOGYDOI: 10.4274/tjh.2018.0195Turk J Hematol 2018;35:298-299Basophilic Stippling and Chronic Lead PoisoningBazofilik Noktalanma ve Kronik Kurşun ZehirlenmesiYantian Zhao,Juan LvCapital Medical University Beijing Chao-yang Hospital, Department of Clinical Laboratory, Beijing, ChinaFigure 1. (A) Bone marrow smears and (B) peripheral blood smears revealing extensive erythrocytes of coarse basophilic stippling (1000 x ,Wright-Giemsa stain). Bone marrow smears showed 4+ iron stores (C) and ring sideroblasts (D) (1000 x , iron stain).A 66-year-old female patient presented with a 9-monthhistory of abdominal colic and fatigue that prompted anabdominal computed tomography scan and gastrointestinalendoscopy with negative assessments. The hemoglobinlevel was 72-81 g/L with an increase in serum ferroprotein.Bone marrow (Figure 1A) and peripheral blood smears(Figure 1B) revealed extensive erythrocytes with coarsebasophilic stippling. It was suggested that there may havebeen an accumulation of heavy metal in her body. The levelof lead in her blood and urine was increased to 1036 µg/L(permissible: <400 µg/L [1]) and 246 µg/L (permissible: <70µg/L [1]), respectively. Her blood mercury level was below thepermissible level (permissible: <15 µg/L [2]). Therefore, shewas initially diagnosed with chronic lead poisoning. Furtherhistory revealed that she had been taking an adulterateddietary supplement called “Fengwangjiang” from unverifiedsources for more than the past 1 year. Bone marrow smearsshowed 4+ iron stores (Figure 1C) and ring sideroblasts (Figure1D), indicating ineffective heme synthesis. She complied withthe doctor’s order to stop taking the dietary supplement andreceived lead-chelation therapy during hospitalization, andher symptoms improved. Basophilic stippling provides a clueto the underlying diagnosis and an understanding of theunderlying pathogenesis.©Copyright 2018 by Turkish Society of HematologyTurkish Journal of Hematology, Published by Galenos Publishing HouseAddress for Correspondence/Yazışma Adresi: Juan LV, M.D.,Capital Medical University Beijing Chao-yang Hospital, Department of Clinical Laboratory, Beijing, ChinaPhone : +86 10-85231523E-mail : juanlv8235@163.com ORCID-ID: orcid.org/0000-0002-2299-120XReceived/Geliş tarihi: June 05, 2018Accepted/Kabul tarihi: September 04, 2018298
Turk J Hematol 2018;35:298-299Zhao Y and Lv J, Basophilic Stippling and Chronic Lead PoisoningKeywords: Basophilic stippling, Chronic lead poisoning, BloodAnahtar Sözcükler: Bazofilik noktalanma, Kronik kurşunzehirlenmesi, KanInformed Consent: It was received.Conflict of Interest: The authors of this paper have no conflictsof interest, including specific financial interests, relationships,and/or affiliations relevant to the subject matter or materialsincluded.Financial Disclosure: This study was supported by the BeijingMunicipal Administration of Hospitals’ Youth Programme(QML20150304) and the Beijing Municipal Administration ofHospitals’ Clinical Medicine Development of Special FundingSupport (ZYLX201805).References1. China National Occupational Health Standards GBZ 37-2015. Diagnosis ofOccupational Chronic Lead Poisoning. Beijing, 2015.2. China National Occupational Health Standards GBZ 89-2007. DiagnosticCriteria of Occupational Mercury Poisoning. Beijing, 2007.299
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Turkish Journal of Hematology Volume: 35 - Issue: 4

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