Page 836 - Williams Hematology ( PDFDrive )

810 Part VI: The Erythrocyte Chapter 52: Erythrocyte Disorders as a Result of Chemical and Physical Agents 811

mechanism of this anemia remains elusive with intriguing observations COPPER
of altered erythropoietin levels and radiolabeling studies of astronaut Erythrocyte damage has resulted from ingestion of copper sulfate in
erythrocytes suggesting selective hemolysis of young erythrocytes less suicide attempts and from copper accumulation when hemodialysis
49
than 12 days old. In addition to space flight, neocytolysis has been fluid is contaminated by copper pipes. 74,75 Hemolysis in Wilson disease
invoked to explain the anemia resulting when high-altitude dwellers has been attributed to the elevated plasma copper levels characteris-
relocate to sea level. 50
tic of that disorder. 76–78 Spherocytic anemia with a hematocrit below
25 percent may be the presenting symptom (see Fig. 52–1C). The
79
LEAD pathogenesis may be related to oxidation of intracellular glutathione,
hemoglobin, and the reduced nicotinamide adenine dinucleotide phos-
Lead poisoning (plumbism) has been recognized since antiquity. The phate (NADPH), along with inhibition of G6PD by copper. However,
80
ingestion of beverages containing lead leached from highly soluble lead the amount of copper required to inhibit G6PD is large. Copper in
based glazes or earthenware containers has been blamed for the decline much lower concentrations inhibits pyruvate kinase, hexokinase, phos-
and fall of the Roman aristocracy and is still an occasional cause of lead phogluconate dehydrogenase, phosphofructokinase, and phosphoglyc-
intoxication. The distillation of alcohol in leaded flasks is another rare erate kinase, suggesting a global metabolic insult. 81,82 Plasma exchange
51
cause of plumbism, although the practice was prohibited in 1723 by successfully prevents hemolytic anemia in Wilson disease. 83
the Massachusetts Bay Colony after it was noticed that consumption of
rum so distilled resulted in abdominal pain known as the “dry gripes.”
51
Among the earliest published descriptions of lead poisoning is a letter RADIATION
written in 1786 by Benjamin Franklin. 52 Although decreased red cell survival is part of the complex series of
Lead intoxication in children generally results from ingestion of events occurring after administration of large doses of total body radi-
flaking lead paint or chewing lead-painted articles. Lead poisoning ation, erythrocytes appear to be very resistant to the direct effects of
tends to be more severe in iron-deficient children, as a relatively close radiation. 84,85 Shortened red cell survival after radiation is likely related
relationship exists between blood lead levels and hematocrit. In adults, to red cell loss through internal bleeding and various secondary events
53
lead poisoning primarily occurs as the result of inhalation of lead com- such as infection.
pounds from industrial processes such as battery manufacture, 54,55 or
ingestion of food having leached lead from pottery or dishes. 56,57 Lead
poisoning from restoring tapestries and producing ceramics also has REFERENCES
been noted. 58,59
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with the erythrocyte cation pump, 65,66 possibly by inhibiting membrane 11. Barretto OC, Cardoso JL, Decillo D: Viscerocutaneous form of loxoscelism and ery-
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erythrocytes, with the hypochromia possibly resulting from coexisting 16. Wright SW, Wrenn KD, Murray L, Seger D: Clinical presentation and outcome of
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71
or coarse, and the number of granules seen in each cell may be quite of Loxosceles gaucho venom acts preferentially upon red cell band 3 transmembrane
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