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A 3-year-old boy is taken to the pediatrician for irritability, constant cramps, and diarrhea. He has always been a very restless child who has a habit of gnawing on everything he comes across. His mother calls his attention constantly for the habit of "gnawing" on the balcony bars. On medical examination he found pale mucous membranes, dark lines on his gums, and dark spots on the sclera of his eyes.

Laboratories Results:
WBC- 14.5x10^9 / L
Hgb- 9.7g / dl
Hct.- 27%
MCV- 77 fl
RDW- 15.5%

Morphology: Microcytic and hypochromic cells, Coarse basophilic strippling, NRBC Poikilocytosis.

Answer the following questions:

1. What is the best explanation for the child's condition?

2. What other laboratory tests are necessary to complete the diagnosis?

3. What is the justification for the presence of this anemia?

1 Answer

1 vote

Answer:

Based on the given information and laboratory results, the best explanation for the child's condition is lead poisoning. The symptoms of irritability, constant cramps, and diarrhea, along with the habit of gnawing on objects, suggest possible lead exposure. The presence of dark lines on the gums and dark spots on the sclera of the eyes are characteristic signs of lead poisoning.

To complete the diagnosis of lead poisoning and further assess the severity and effects, additional laboratory tests may be necessary. These tests may include:

a. Blood lead level: This test measures the concentration of lead in the blood and helps confirm the diagnosis of lead poisoning. Elevated levels indicate lead exposure.

b. Zinc protoporphyrin (ZPP) level: ZPP levels can be elevated in lead poisoning. This test helps assess the inhibition of heme synthesis caused by lead.

c. Renal function tests: Lead poisoning can affect kidney function, so assessing renal function through tests like blood urea nitrogen (BUN) and creatinine may be necessary.

d. Liver function tests: Lead poisoning can also affect liver function, so tests such as liver enzymes (AST, ALT) and bilirubin may be performed.

e. X-ray or abdominal ultrasound: Imaging studies may be used to assess the presence of lead-containing foreign bodies or evaluate any potential damage to organs like the kidneys or liver.

The justification for the presence of this anemia in lead poisoning lies in its effects on the production and lifespan of red blood cells. Lead interferes with heme synthesis, leading to impaired red blood cell production and shorter lifespan. The specific findings in the laboratory results, such as microcytic and hypochromic cells, coarse basophilic stippling, NRBC (nucleated red blood cells), and poikilocytosis, are characteristic of lead poisoning-induced anemia. The inhibitory effects of lead on enzymes involved in heme synthesis result in abnormal red blood cell morphology and decreased hemoglobin production, leading to the observed anemia.

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