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Iron deficiency anemia in an older man — ABIM Board MCQ

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HardHematology/OncologyIron deficiency anemia in an older manABIM Board

A battery-recycling worker has abdominal colic, wrist extensor weakness, microcytic anemia with basophilic stippling, blood lead level 112 microg/dL, confusion, and a generalized seizure. Which management is most appropriate?

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Correct answer: A — Remove exposure and begin parenteral chelation under toxicology guidance

The best answer is “Remove exposure and begin parenteral chelation under toxicology guidance”. Neurologic dysfunction at a very high blood lead concentration is lead encephalopathy, a medical emergency. The patient requires hospitalization, exposure removal, seizure and airway management, and parenteral chelation—typically calcium disodium EDTA with dimercaprol—under expert toxicology guidance. Oral succimer is used in selected less severe poisoning but is inadequate as sole therapy for encephalopathy. Iron therapy, phlebotomy, and dialysis alone do not treat the tissue burden.

Reference: CDC/ATSDR Medical Management Guideline: Lead: https://wwwn.cdc.gov/TSP/MMG/MMGDetails.aspx?mmgid=1203&toxid=22