Lead Toxicity in the Pediatric Patient with Sickle Cell Disease: Unique Risks and Management

Abstract

Lead toxicity is the result of lead ingestion, one of the most common ingestions in the pediatric population. Nationwide and statewide efforts to recognize and curtail this epidemic have led to declining rates of toxicity. In patients with sickle cell disease (SCD), lead toxicity can be an elusive diagnosis due to overlapping symptom profiles, and inconsistent follow-up with a primary care physician can make the diagnosis even more difficult. In this article, two illustrative cases of lead toxicity in patients with SCD are described. The discussion reviews the current risk factors, screening, and inpatient management of lead toxicity, as well as describing the unique and sometimes confounding presentations of lead toxicity versus sickle cell crisis. [Pediatr Ann. 2018;47(1):e36-e40.].

Syndrome of Inappropriate Antidiuretic Hormone Secretion and Lead Toxicity in a Child With Sickle Cell Disease and Pica

“…Issaivanan et al reported a prevalence of pica to be 76% in younger children [ 6 ]. Jung et al noted multiple additional risk factors for young children to develop lead poisoning including lower socioeconomic status, black race, and Hispanic ethnicity [ 8 ]. In addition, an incomplete blood-brain barrier allows for increased lead penetration to the developing brain [ 8 ].…”

“…Jung et al noted multiple additional risk factors for young children to develop lead poisoning including lower socioeconomic status, black race, and Hispanic ethnicity [ 8 ]. In addition, an incomplete blood-brain barrier allows for increased lead penetration to the developing brain [ 8 ]. Patients with sickle cell anemia more commonly have iron deficiency anemia, which leads to increased gastrointestinal absorption of lead [ 8 , 9 ].…”

“…In addition, an incomplete blood-brain barrier allows for increased lead penetration to the developing brain [ 8 ]. Patients with sickle cell anemia more commonly have iron deficiency anemia, which leads to increased gastrointestinal absorption of lead [ 8 , 9 ].…”