The Serum Lead level in Patients With Retained Lead Pellets

Moazeni, Mohammad; Alibeigi, Faramarz Mohammad; Sayadi, Masoud; Mofrad, Ebrahim Poorya; Kheiri, Soleiman; Darvishi, Malihe

doi:10.5812/atr.18950

Cited by 14 publications

(12 citation statements)

References 13 publications

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“…This study shows that there were significantly higher BLLs in the test group than in the control group. This finding is in agreement with previous studies1819 where comparison of BLLs was done between those with and without retained lead missiles (pellets, bullets, and shrapnel) where higher BLL was seen in those with retained missiles in their bodies. This is expected since, in most developed and developing countries such as Nigeria, there is a reduction in environmental and occupational lead exposures due to the ban in leaded gasoline and the reduction in the use of lead in plumbing 20.…”

Section: Discussionsupporting

confidence: 93%

Hematological indices of patients with retained lead pellets in the craniomaxillofacial region following gunshot wounds

Edetanlen

Saheeb

2018

Niger Med J

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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.

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Section: Discussionsupporting

confidence: 93%

Hematological indices of patients with retained lead pellets in the craniomaxillofacial region following gunshot wounds

Edetanlen

Saheeb

2018

Niger Med J

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“…The mean BLL of the study subjects was higher than that of their control counterpart (Table 2). This result is similar to the findings of Araújo et al, 15 Nguyen et al, 17 Moazeni et al, 20 and Farrell et al 12 Following the absence of occupational and environmental exposure of both the patients and their control subjects, the only possible explanation for the higher levels of lead among the patients is undoubtedly the presence of retained missiles.…”

Section: Discussionsupporting

confidence: 90%

Effect of bone fracture(s) on blood lead levels from retained lead pellets in craniomaxillofacial region

Edetanlen

Saheeb

2019

Hum Exp Toxicol

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Background: Missile-related blood lead elevations and toxicity are well documented in the literature but reports on its associated risk factor(s) are few. Objective: To determine if bone fracture(s) contribute to an elevated lead blood level. Method: This is a prospective study of subjects with retained pellets in the craniomaxillofacial region following gunshot injuries who met the inclusion criteria. Blood samples were collected from the test subjects and their corresponding control subjects via venipuncture. Collected blood samples were used for blood lead measurement by the wet method of the atomic absorption spectrophotometry. Using appropriate statistical tests, p < 0.05 was considered significant. Results: A total number of 48 subjects were studied. The mean blood lead levels (BLLs) of the study population were 6.88 ± 1.17 µg/dl while that of the control group was 1.52 ± 0.87 µg/dl and the mean difference was statistically significant ( p = 0.03). The mean and standard deviation of BLL of subjects with fractures were 4.77 ± 0.9, 5.08 ± 1.0, and 5.22 ± 1.0 µg/dl at days 3, 21, and 42 postinjury, respectively, while for those without bone fractures were 3.07 ± 1.4, 3.70 ± 0.8, and 4.33 ± 1.7 µg/dl. The difference was statistically significant ( p = 0.04). Conclusion: Subjects with bone fractures were found to have higher BLLs than those without bone fractures, where pellets were retained in their bodies.

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“…In 2014, Moazeni et al[ 14 ] reported a comparison of 25 patients with some retained lead pellets in their bodies and the same number of volunteers without similar lead exposure. The results showed lead levels of 29 (± 12.8) μg/dL and 25.3 (± 6.4) μg/dL in case and control groups, respectively, without any significant difference (p = 0.3).…”

Section: Discussionmentioning

confidence: 99%

“…The reports of Moazeni et al . [ 14 ] and McQuirter et al . [ 6 ] found relations between exposure time and blood lead levels.…”

Section: Discussionmentioning

confidence: 99%

Lead Toxicity Risks in Gunshot Victims

et al. 2015

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BackgroundGunshot wounds require surgeons to decide whether to remove or leave bullet fragments in the body. Surgeons also decide how to follow up with patients who have lead fragments retained in their body. Current literature recommends to remove only intra-articular fragments without the need for a follow-up for patients with the metal retained. Therefore, this study investigates chronic lead toxicity for gunshot wounds.MethodsThe study was performed in the metropolitan area of Rio de Janeiro/Brazil, between 2013 and 2015. It was a case-control study that included 45 victims of gunshot lesions with metallic fragments retained for more than 6 months. The 45 controls were matched for gender, age, and race. We compared the lead blood levels and frequency of symptoms.ResultsThe control group had average blood lead levels of 2.17 μg/dL (95% Confidence Interval [CI]; 1.71–2.63) and median 2.1 μg/dL. The case group had average values of 9.01 μg/dL (CI; 6.07–11.96) and median values of 6.5 μg/dL with p-values < = 0.001. The case group reported the following more frequently: irritancy, bad mood, headache, memory losses, daylight drowsiness, myalgia, weakness, abdominal pain, joint pain, trembling, tingling limbs. There was statistical significance for the differences of symptoms frequencies and for odds ratio between groups.ConclusionsAlthough the mean lead levels found were lower than the current laboratory references, low levels have been associated with both rising morbidity and mortality. The WHO stated: “There is no known level of lead exposure that is considered safe”. In conclusion, this work showed that bullets retained in the body are not innocuous. There are impacts in the blood lead levels and symptoms related to it, even with few fragments, extra-articular located or existing with low blood lead levels.

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The Serum Lead level in Patients With Retained Lead Pellets

Cited by 14 publications

References 13 publications

Hematological indices of patients with retained lead pellets in the craniomaxillofacial region following gunshot wounds

Hematological indices of patients with retained lead pellets in the craniomaxillofacial region following gunshot wounds

Effect of bone fracture(s) on blood lead levels from retained lead pellets in craniomaxillofacial region

Lead Toxicity Risks in Gunshot Victims

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