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In 1991, CDC recommended Universal blood lead level testing for
children.
9-05-2022 INVESTIGATION - LEAD 1
DETECTION OF LEAD
DR KOMAL JADHAV
2ND YEAR PG SCHOLAR
DEPT. OF AGADA TANTRA
Introduction
 Lead was one of the first metals known to man and have been widely
used during the last 2000 years for domestic, industrial and therapeutic
purposes.
It is abundant in soil, being distributed throughout the earth’s crest.
9-05-2022 INVESTIGATION - LEAD 3
Lead appear as a trace metal in virtually all foods and beverages(lead-
soldered canned ) though fortunately absorption from such sources is
relatively low.
Adults ingest 300mg and inhale 15mg of lead approximately each day,
on which only 10% is absorbed, but children may absorb up to 50%.
Lead in drinking water may be absorbed to greater extent than in food.
9-05-2022 INVESTIGATION - LEAD 4
Lead is heavy, soft, steel-grey metal which gives off toxic fumes when
it is melted.
Lead and its compounds are toxic.
Lead is the commonest metal involved in chronic poisoning.
When it combines with Sulphhydryl enzymes and inhibits cell
metabolism.
It inhibits some of the enzymes required for heme synthesis and
causes anemia.
9-05-2022 INVESTIGATION - LEAD 5
CONTENTs
Introduction
Objectives
History
Types of Investigation
Instruments
Methods of Investigation
Method of calibration and possible errors
Application
Incarporation of own research view
Summary
References
9-05-2022 INVESTIGATION - LEAD 6
Objectives
oTo understand the various investigations to rule out lead toxicity
9-05-2022 INVESTIGATION - LEAD 7
History
 The toxic effects of arsenic, mercury, and lead were known to the ancients, but
methodical studies of the toxicity of some heavy metals appear to date from only 1868.
 In the year, Wanklyn and Chapman speculated on the adverse effects of the heavy metals
"arsenic, lead, copper, zinc, iron and manganese" in drinking water.
 Lead Poisoning -
9-05-2022 INVESTIGATION - LEAD 8
Types of Investigation
Blood Investigations
Urine Investigations Bone Investigations
9-05-2022 INVESTIGATION - LEAD 9
Analytical Method Radiological Method
INSTRUMENTS
oMicroscope
oAutomated hematology analyser
oInductively coupled plasma mass spectrometry
oElectrothermal atomic absorption spectrometry etc
oX-RAY radiations
9-05-2022 INVESTIGATION - LEAD 10
A) BLOOD
TOTAL BLOOD COUNT
DIFFERENTIAL COUNT
PERIPHERAL BLOOD SMEAR
BLOOD LEAD LEVEL – AAS, EAAS, ASV, ICPAES, MS, X – ray
fluorescence, PIXE
CHEMICAL TESTS
9-05-2022 INVESTIGATION - LEAD 11
• EARLY STAGE - ANAEMIA associated with polycythaemia with
polychromatophilia.
• LATER STAGE - ANAEMIA associated with Normo/Hypochromic
polychromasia,
Punctate basophilia/Basophilic Stippling
Reticulocytosis( increase in no of premature cells)
Anisocytosis(abnormal shape)
Poikilocytosis(increases in no abnormal shape RBCs)
Sideroblasts (nucleated RED cells)
Increase in mononuclear cells
Decrease in polynuclear cells and platelets
9-05-2022 INVESTIGATION - LEAD 12
PERIPHERAL BLOOD SMEAR
9-05-2022 INVESTIGATION - LEAD 13
PUNCTATE /BASOPHILIC
STIPPLING
Presence of many dark blue coloured
pinhead sized spots( Ribosomes) in
the cytoplasm of blood cells.
INFERENCE
Hypochromia and Basophilic Stippling – lead intoxication
Basophilic Stippling – chronic poisoning
9-05-2022 INVESTIGATION - LEAD 14
BLOOD LEAD LEVEL
oMILD – BL 20 to 35 mg/100ml
oMODERATE – 45 to 75 mg/100ml
oSEVERE _ >75 mg/100ml
• Accepted BL is 35 mgm/100ml in adults
• In children <5mgm/100ml is acceptable.
9-05-2022 INVESTIGATION - LEAD 15
Electromagnetic Atomic
Absorption Spectrometry,
Anodic Stripping
Voltammetry
Inductively Coupled Plasma
Atomic Emission
Spectroscopy
ATOMS IONS
DETECTOR
CHEMICAL TESTS
 HCL ACID TEST - HCL acid produces a white precipitate, soluble in
boiling water but insoluble in ammonia.
POTTASIUM IODIDE TEST – potassium iodide gives a yellow
precipitate, insoluble in boiling water, but reappears on cooling
9-05-2022 INVESTIGATION - LEAD 16
B)URINE
ALA – fluorometry
URINE LEAD LEVEL
URINE PORPHYRIN LEVEL
Calcium disodium EDTA mobilization test –
9-05-2022 INVESTIGATION - LEAD 17
ALA – FLUOROMETRY
• Delta – ALA is a protein
9-05-2022 INVESTIGATION - LEAD 18
URINE PORPHYRIN LEVEL
• heme containing protein – 20 to 120mg / L
9-05-2022 INVESTIGATION - LEAD 19
URINE LEAD LEVEL
• <150mgm/L Normal for adults
• <80mgm/L Normal for children
• >500mgm/24hours in children – indication for chelation therapy
9-05-2022 INVESTIGATION - LEAD 20
Calcium disodium EDTA mobilization test
 only suitable for children BL 25 – 41mcg/100ml’
 The test positive when lead excretion ratio is >0.6____childrens
should undergo chelation therapy
9-05-2022 INVESTIGATION - LEAD 21
C)BONE
9-05-2022 INVESTIGATION - LEAD 22
X -RAY
Radiation – Lead particles stimulation –
Detector - Reflects the image
Through regression equations we can estimate
mean skeletal lead concentration of the entire
body
EPIPHYSEAL
LINE
possible errors
external contamination of sample.
Non calibrated instruments.
Only single test is not reliable for diagnosing the lead posing.
9-05-2022 INVESTIGATION - LEAD 23
Application
These investigations are helping to know the level of lead in our body
and for application of appropriate treatment.
Early detection of lead levels in the body helps in preventing the
chronic poisoning.
Helping for quantitative and qualitative measurement.
9-05-2022 INVESTIGATION - LEAD 24
Incarporation of own research view
• In Ayurveda, some tests can be introduced to detect such kind of
toxicity
9-05-2022 INVESTIGATION - LEAD 25
STOP LEAD POISONING
9-05-2022 INVESTIGATION - LEAD 26
References
• Textbook of MODERN MEDICAL TOXICOLOGY by V V Pillay.
• MEDICAL JURISPTRUDENCE AND TOXICOLOGY by Rai
Bahadur JAISING P. MODI
9-05-2022 INVESTIGATION - LEAD 27
9-05-2022 INVESTIGATION - LEAD 28

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DETECTION OF LEAD.pptx

  • 1. In 1991, CDC recommended Universal blood lead level testing for children. 9-05-2022 INVESTIGATION - LEAD 1
  • 2. DETECTION OF LEAD DR KOMAL JADHAV 2ND YEAR PG SCHOLAR DEPT. OF AGADA TANTRA
  • 3. Introduction  Lead was one of the first metals known to man and have been widely used during the last 2000 years for domestic, industrial and therapeutic purposes. It is abundant in soil, being distributed throughout the earth’s crest. 9-05-2022 INVESTIGATION - LEAD 3
  • 4. Lead appear as a trace metal in virtually all foods and beverages(lead- soldered canned ) though fortunately absorption from such sources is relatively low. Adults ingest 300mg and inhale 15mg of lead approximately each day, on which only 10% is absorbed, but children may absorb up to 50%. Lead in drinking water may be absorbed to greater extent than in food. 9-05-2022 INVESTIGATION - LEAD 4
  • 5. Lead is heavy, soft, steel-grey metal which gives off toxic fumes when it is melted. Lead and its compounds are toxic. Lead is the commonest metal involved in chronic poisoning. When it combines with Sulphhydryl enzymes and inhibits cell metabolism. It inhibits some of the enzymes required for heme synthesis and causes anemia. 9-05-2022 INVESTIGATION - LEAD 5
  • 6. CONTENTs Introduction Objectives History Types of Investigation Instruments Methods of Investigation Method of calibration and possible errors Application Incarporation of own research view Summary References 9-05-2022 INVESTIGATION - LEAD 6
  • 7. Objectives oTo understand the various investigations to rule out lead toxicity 9-05-2022 INVESTIGATION - LEAD 7
  • 8. History  The toxic effects of arsenic, mercury, and lead were known to the ancients, but methodical studies of the toxicity of some heavy metals appear to date from only 1868.  In the year, Wanklyn and Chapman speculated on the adverse effects of the heavy metals "arsenic, lead, copper, zinc, iron and manganese" in drinking water.  Lead Poisoning - 9-05-2022 INVESTIGATION - LEAD 8
  • 9. Types of Investigation Blood Investigations Urine Investigations Bone Investigations 9-05-2022 INVESTIGATION - LEAD 9 Analytical Method Radiological Method
  • 10. INSTRUMENTS oMicroscope oAutomated hematology analyser oInductively coupled plasma mass spectrometry oElectrothermal atomic absorption spectrometry etc oX-RAY radiations 9-05-2022 INVESTIGATION - LEAD 10
  • 11. A) BLOOD TOTAL BLOOD COUNT DIFFERENTIAL COUNT PERIPHERAL BLOOD SMEAR BLOOD LEAD LEVEL – AAS, EAAS, ASV, ICPAES, MS, X – ray fluorescence, PIXE CHEMICAL TESTS 9-05-2022 INVESTIGATION - LEAD 11
  • 12. • EARLY STAGE - ANAEMIA associated with polycythaemia with polychromatophilia. • LATER STAGE - ANAEMIA associated with Normo/Hypochromic polychromasia, Punctate basophilia/Basophilic Stippling Reticulocytosis( increase in no of premature cells) Anisocytosis(abnormal shape) Poikilocytosis(increases in no abnormal shape RBCs) Sideroblasts (nucleated RED cells) Increase in mononuclear cells Decrease in polynuclear cells and platelets 9-05-2022 INVESTIGATION - LEAD 12
  • 13. PERIPHERAL BLOOD SMEAR 9-05-2022 INVESTIGATION - LEAD 13 PUNCTATE /BASOPHILIC STIPPLING Presence of many dark blue coloured pinhead sized spots( Ribosomes) in the cytoplasm of blood cells.
  • 14. INFERENCE Hypochromia and Basophilic Stippling – lead intoxication Basophilic Stippling – chronic poisoning 9-05-2022 INVESTIGATION - LEAD 14
  • 15. BLOOD LEAD LEVEL oMILD – BL 20 to 35 mg/100ml oMODERATE – 45 to 75 mg/100ml oSEVERE _ >75 mg/100ml • Accepted BL is 35 mgm/100ml in adults • In children <5mgm/100ml is acceptable. 9-05-2022 INVESTIGATION - LEAD 15 Electromagnetic Atomic Absorption Spectrometry, Anodic Stripping Voltammetry Inductively Coupled Plasma Atomic Emission Spectroscopy ATOMS IONS DETECTOR
  • 16. CHEMICAL TESTS  HCL ACID TEST - HCL acid produces a white precipitate, soluble in boiling water but insoluble in ammonia. POTTASIUM IODIDE TEST – potassium iodide gives a yellow precipitate, insoluble in boiling water, but reappears on cooling 9-05-2022 INVESTIGATION - LEAD 16
  • 17. B)URINE ALA – fluorometry URINE LEAD LEVEL URINE PORPHYRIN LEVEL Calcium disodium EDTA mobilization test – 9-05-2022 INVESTIGATION - LEAD 17
  • 18. ALA – FLUOROMETRY • Delta – ALA is a protein 9-05-2022 INVESTIGATION - LEAD 18
  • 19. URINE PORPHYRIN LEVEL • heme containing protein – 20 to 120mg / L 9-05-2022 INVESTIGATION - LEAD 19
  • 20. URINE LEAD LEVEL • <150mgm/L Normal for adults • <80mgm/L Normal for children • >500mgm/24hours in children – indication for chelation therapy 9-05-2022 INVESTIGATION - LEAD 20
  • 21. Calcium disodium EDTA mobilization test  only suitable for children BL 25 – 41mcg/100ml’  The test positive when lead excretion ratio is >0.6____childrens should undergo chelation therapy 9-05-2022 INVESTIGATION - LEAD 21
  • 22. C)BONE 9-05-2022 INVESTIGATION - LEAD 22 X -RAY Radiation – Lead particles stimulation – Detector - Reflects the image Through regression equations we can estimate mean skeletal lead concentration of the entire body EPIPHYSEAL LINE
  • 23. possible errors external contamination of sample. Non calibrated instruments. Only single test is not reliable for diagnosing the lead posing. 9-05-2022 INVESTIGATION - LEAD 23
  • 24. Application These investigations are helping to know the level of lead in our body and for application of appropriate treatment. Early detection of lead levels in the body helps in preventing the chronic poisoning. Helping for quantitative and qualitative measurement. 9-05-2022 INVESTIGATION - LEAD 24
  • 25. Incarporation of own research view • In Ayurveda, some tests can be introduced to detect such kind of toxicity 9-05-2022 INVESTIGATION - LEAD 25
  • 26. STOP LEAD POISONING 9-05-2022 INVESTIGATION - LEAD 26
  • 27. References • Textbook of MODERN MEDICAL TOXICOLOGY by V V Pillay. • MEDICAL JURISPTRUDENCE AND TOXICOLOGY by Rai Bahadur JAISING P. MODI 9-05-2022 INVESTIGATION - LEAD 27