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Background: Acute and chronic environmental lead exposures are associated with alteration of hematological parameters. It is not known whether retained lead pellets have similar effects on hematological variables to environmental exposures. Objective: The objective of this study is to assess the effects of retained lead pellets on hematological indices in patients that sustained gunshot injuries to the craniomaxillofacial region. Patients and Methods: We examined individuals with retained pellets following gunshot injuries to the craniomaxillofacial region using a prospective cohort study design in a tertiary health center, Nigeria. Results: A total of 54 male individuals (27 in each group) enlisted in the study. The age of the patients and control subjects ranges from 20 to 58 years, with a mean age of 40.3 years. The mean blood lead levels (BLLs) of the exposed group were lower than the unexposed ( P = 0.03). There were statistically significant ( P < 0.05) variations in the hematological indices between the exposed and the unexposed groups. There was a significant association ( P < 0.001) between the hematological indices assessed and the BLLs, number of retained pellets, and duration of retention. No basophilic stippling was observed in the red cell morphology of the individuals. Conclusion: Retained lead pellets cause significant elevated BLL and associated higher hematocrit, hemoglobin concentration, and mean cell volume.