Coarse basophilic stippling in lead poisoning

A 62-year-old woman presented with persistent periumbilical pain. She was found to have normochromic normocytic anemia (hemoglobin, 6.4 g/dL) and mild renal impairment (urea, 6.2 mmol/L; creatinine, 149 mmol/L). Gastrointestinal endoscopy was unrevealing. After admission, the patient developed generalized seizure. Blood film examination revealed frequent coarse basophilic stippling of red cells (original magnification 3100, Wright-Giemsa stain). Blood lead level was markedly raised (151 mg/dL; normal is ,5 mg/dL). Dimercaptosuccinic acid chelation was commenced with subsequent improvement in hemoglobin level and renal function. Further history revealed that the patient consumed multiple herbal supplements for more than 1 year. A local toxicology reference laboratory detected extremely high lead levels in 1 of the herbal supplements (108 389 mg/mL). For reference, the US Food and Drug Administration adopts 0.5 mg/mL as the maximum level allowed for lead in products intended for use by children.