Document MNgvnLGwqJ8dDVY62qjRR2Qk

a *I "Cpx.&a *is I C35IH 'rfMIdiari in Ir THE CONCENTRATION OF LEAD IN PLASMA. WHOLE BLOOD AND ERYTHROCYTES OF INFANTS .portal. Lr ilicini dir* AND CHILDREN de frbrc r By Morton J. Robinson* M.D,, Ftlii S. Korpinski, Jr,, M.D.. nte acitnn- end Heinrich Briefer, M.D. - 'K "phsiM- Deportment* of Pediatries and Preventive Medicine, Jcferton Medical College of Philadelphia ibilitntc c* IC, IKMlITO* a -fia cssitr es pit e the efforts directed toward the 103 children in relation to' their age. The D prevention of accidental lead poison* children, ranging in age from 5 hours to 13 a| in infants and children, ingestion of leadyears, were selected from the .pediatric .till constitutes a serious and frequent hazeactimi dr . ad to health. The more severe forms; of inciiliiitimi. a PAS * ' 'jfumhism in children are associated With 3 die. post kgh mortality , rate and marked frequency S. <f disabling sequelae affecting the nervous leamruluM1 mton. in addition, aitereffects in the 1001' wards, nurseries and outpatient depart ments of the Jefferson Medical College Hospital. Inclusion in the survey required that the child have a normal temperature and give no history of pica, previous lead poisoning, or symptoms suggestive of lead e eruption rf chronic nephritis appear to be much poisoning. _ * typie, Ir ;. Lee frequent and impurtantithan generally rensibilitatr J iffiogiMaed.1-' Recently published data in- si on presta 'Sikate that current methods of treatment urrentia. al i. W thus far not significantly altered the prriiwhi dr , sodality rate, although the incidence of rticular rptr e on 1a V neurologic sequelae may have been re- reaction dr ted;.* Earlier diagnosis and immediate istra (trl niaoval from exposure, together with JJ pen caistr yu prompt specific and supportive therapy, r protectiioi K dmId give still better results, id mortal r* * Clinical experience suggests that many so A- iimli- ; ikddren may be virtually asymptomatic for big periods of time even though the con- (nitration of lead in the blood is abnormally J high. TTiis condition represents latent t detaic lead poisoning. Continued exposure * t Iced, intercurrent febrile illness, or ncido- METHODS As a rule, 10 ml of blood were collected in a defended syringe, transferred to a centrifuge tube, and centrifuged at 1550 rev/min for 30 minutes. A modified dilhizone method previ ously dewjrilicd by Rfeders*-* was used. Since this method is employed routinely in this laboratory and since it was difficult to obtain larger samples, only one determination was made on each sample.* lu 82 of the 103 cases, the content of lead of compacted erythrocytes about 3`i plasma) and of the plasma separately: to provide a total the results were combined. From remaining 21 subjects, fess than had'been'drawn. and only whole examini-d. m* may transform the latent into the active RESULTS hpr of load poisoning.*-* It is important. fewfnre, to recognize asymptomatic latent In S3 of the 82 cases studied for-lead in | tad poisoning characterizediby abnormally erythrocytes and plasma, lead was not de fj Ugh concentrations of lead in the blood. tected in the plasma. Concentrations of. * fie literature am lead jOTisoning reveals dis- 0.009 mg/100 ml or less were found in 22* ^ tgremedt as to whai:' constitutes an ab- ensest hemolysis had taken place in seven ^ Mentally high concentration1 of lead in the samples in which more than 0.009 mg/100 ,* Ihsd of children. It is the purpose of this paper to present tlie results of a study of ik concentration of lead in the blood of * The standard deviatiun for replicate determi nations nf lead in a given specimen of Mood is approximately St hy tins method. (Submitted October 2, accepted November 25. 1957.) AODRiSS: (H.B.) 1025 Welnut Street, Philadelphia 7, Pennsylvania. Ps d iat s u c s , May 1838 9 N11873 0007-SWP-000005841 <" 794 - LEAD ml was in evidence. These findings agree with previou* report*.* The range fur erythmcytes mi 0.003-0.144 mg/100 ml. ami fir whole hinml. 0.003-0.054 mg/lOOml. The conetiitratinn of lead in tlie blood nl the 103 children examined did not srein to be related to sea; or race. In order to evalu ate the role of age. the subjects were di vided into three groups. Croup I included infants ranging from 5 hours to 6 months of age. This group had, in all probability, ab sorbed only minimal amounts of lead other than that presrint in the food. In Croup 11 were infants and children from 6.1 months to 4 years of a**e. These wore children in the teething age who test their environment with their mouths. Croup III consisted of children more than 4 years of age. The loglog relationship between age and content of lead of whole blood and erythrocytes, respectively, is shown in Figures 1 and 2. The ranges and medians in the threw groups were determined and compared. Since it has been shown (hat the distribution curve for concentrations of lead is log-normal,"' the use of the arithmetic mean is precluded. Geometric means could have been used, but it was thought that the median would lie more meaningful. The ranges and medians T.UII.K I Nwt *vu It i\ea or Cnwtvnition or l.r.u> t h e Riano or im Cmirmex H kJr W.-W ("If tin ml) ' (mt Idiml) Mi-lian <tmu|i I 0.011 (1.034 Median II ami . III Rir 1 Range (inium II and 0.IH7 Q.WU-IMOI n<j O.OIli-O.esn III (in|i II n imI 111 O.UUSl-O.OM O.WB-O.lli die UH^e (ik h ^s II a im! ISI Middk-.vi% U.filS-O.IMO <M10Mi.ll9t a.otB-o.im o.ute-s.mt Nmitinf id wiijn-b Gm|i I Numlitf *f sulijtvtii Ufttitp* il ninl HI Tubl mimUr f win jeet* M R 1US u IT m of Group II were practically identical with * tlmse of Croup 111. and these two groups were therefore combine.! in all further 1eolations. Various ranges and medians anshown in Table 1. The distributions of con centrations of lead in whole blood and erythroevtes in Croup 1 were displaced signiS- 1 canflv to the left of the distributions in thr I S-r- 1, !3 i r4 004 .005.00*4 A0i|- Kic. * R. I.. combined group test'* demonstfati fcrence (pruhahih months of age. th the blood reinaii approaching the for adults. Fie. 1. Relationship between concentration of lead in whole blood and age of 104 children. 01 As mentioned a Sty in regard to li-atl ill the ulmli clinical imeitigat lxduu- O.ilh ing'K* accept O.tft ing/H* normal. Much of is due to the methods and tec the discrepant S: applied to chihlr. Icy el al.'' stall normal in whole This figure agree fants and childrt older while, acco investigation, the a is significantly lo- 0007-SWP-000005842 ar t ic l es I A i 9 s 4 i AM OH 5T At*; .089.004' .003.09$ i i * :-*. :*.* AOI* .8 4 4.S >1 I I T t J to Ag (month*) i CO so too Fk ;. 2. Relationship between cimciiitration if U-.id in cnthrocyte-s ami age <*f 82 children. P* tnnbined group (II and III). The rank Appreciable amounts of lead were found A , mi" demonstrated a highly significant dif- in the whole blood (0JU07-0.02S mg/100 ml) irr* btcnce (probability of H < 0.001). After 6 and erythrocytes (0.010-0.04-1 mg/100 mil wi ntrntbs of age, the concentration of lead in of newborn infants. This raises the question th- ; lie blood remained independent of age. of transport of lead from the maternal into ifi- ^ranching the "normal" values reported the fetal circulation. Since there is little or `Jhe hr adults. no proof that, fn a normal pregnancy, ma DISCUSSION ternal blood cells enter the fetus in a sizable number, it is in all probability the ma As mentiom*d above, there is no unanim- ternal plasma in which minute amounts of ,h m regard to normal concentrations of lead are carried to the Fetus. Several in bid in the whole blood of children. Most vestigators'1 Itavc detected lead in fetal ' rEnicil investigators'- consider values tissues. Studies ou experimental animals . Wow 0.(18 mg/100 ml normal, while sane11 have sltcnvn that lead moves into tlw circti- - - inept 0.08 mg/100 ml as the tipper limit of lation of tlic placenta and then into the ^nrmal. Much of the difference of opinion fetus/9 although there is no accumulation ? due to the us* of dileraai analytic of lead in the placenta.*" This transfer of aedtnds and techniques and the fact that lead is made as though no barrier existed 6c discrepant findings is adults have been between the blood of the mother and the i applied to children. Is a recent paper. Brad- blood of the fetus.** 9 W rt ml."* state that the upper level of With increasing age, a significant rise in aunwlin whole Moral is (MB mg/100 ml. tlic content of lead of the erythruev tes oc This figure agrees with our findings in in- curred within Croup I. This increase was Luts and children 6.1 months of age and not reflected in the lead level of the whole ' oiler while, according to the results of this blood, possibly as a result of a declining ra ' inestimation, the figure for younger infants tio of cells to plasma. Further studies of .' s significantly lower. individual infants at fixed intervals during 0007-SWP-000005843 798 LEAP tlse first 6 month* 'of life are necessary to confirm ami to explain this observation. liipathv hi children. Pzoi.vnucs, 19:2. 1937.' 3. Btcrs. H. K.. .ind M.ilimf. C.: Edatlumil SUMMARY caictiim-diMKiiiun (Vprscnate) in treat ment of lead poisoning id children. The concentration of lead in the blood of Am. j. Dis Child.. 07:559. 1934. 103 infants and children without history of 8. NIcKhaim. C. F., and Karpinski, F. E-. pica or lead poisoning, ranging in age from h hours, to 13 years, was studied. The chil dren were divided into three groups ac Jr.: Lead poisoning, in Hremiemunn* Practice of Pediatrics, VoL I, edited by I. McQnarne. I Hagerstown. Prior, 393?, chap. 15: cording to age: Group 1. 5 hours to 6 7. Karpinski. F. E.. Jr.. Rieders. F., arid 'months of age; Group II, 6.1 months to 4 years of age; Group III. older than 4 years. ' The values obtained in Group 1 were significantly lower than those obtained in Cirsh. L. S-: Calcium disodntm verscoate in the tlierapv of lead eii.rpliabpi athv. J. Prdiut.. 48:087. 1933. 8. Rieders, .. Dunningtim. W, G.. and Brieger, H.: TJie efficacy of edslthamfi Groups II and Ilf. Groups II and III calcium disodium in the treatment of slrnwed approximately the same content of lead in wlxtle blood and erythrocytes. The Median values in Group I were 0.015 mg/ 100 ml of whole blood and 0.034 mg/100 ml occnpalinnal lead piwarning. Indnst. Med.. 34:195, 1933. 9. Willoughby, C. E.. and Wilkins, E. S, Jr.: 'The lead content of human blood. J. Biol. Chctn.. 124.339. 1930. of erythrocytes. In the combined Groups II 10. Vouk. V. B.. Volcder, K-. Weber. O. A.. and 111 median values ini whole blood were 0.0:27 rng/100 ml, and in erythrocytes 0.085 ikig/100 ml. The range in Group I was 0.005-0.(01 mg/100 ml of whole blood and and Puree. L.: Xormal values of lead concentration in human blood. Arh. big. rada., 0:277. 1955. 11. Kricskal. W. H.. and Wallis, W. A.: Use of ranks in one criterion variance analy 0. 010.0.090 mg/100 ml of erythrocytes. In sis. J. Am. Statist. A., 47:583, 1952. ' th<j*;. two groups more than 6 months of age, the range for whole blood was found to be <^003-0.054 mg/100 ml. and for erythrocytes 0j003-0144 mg/lbo | moulds of the values 12. Tanis, A. L.: Lead poisoning in children. Am. J. Di*. Child., 09:323. 1933. 13. Editorial: Lead poisoning in children. Brit. M.J., 2:894.1953. 14. Chisolm, J. J.. Jr., and Harrison, H. E.: . The exposure of children to lead. Ftat- (\t'hole blfd),amibe^vgn 0i>3 and0.103 a t k ic s . 18.943.1936. 13. Winters, R. W.: Lead poisoning in chil dren*. GP. 13.107, 193. SignrScant asin-iiwnts%f lead wer fewad in 10. Bradley, J. E., Powell. A. E., Xiermann, tie' ^Ittlelj!|i|||||j|i||'!&p2S mg/100 ml), W,, McCrady. K. R.. and Kaplan, .: aiid crythrocytes (0.0104)i:'344 sng/lOO ml) of The incidence of abnormal blood levds of lead in a metropolitan pediatric clinic. J.Pediat., 49.1.1936. REFERENCES 1. Henderson, D. A.: A follow-up ef cases of phtrabfara ia cMdran. Australasian 17. Kenos, R. A.. Thamann, F., and Chdak, J.: Oa the normal absorption and excre tion of lead. J. Indust. Hi*. A To*., 15:237, 1933. 18. Tompsett. S. L,, and Anderson, A. B.: 2. Henderson, D. A.: Otrenfc nephritis m Lead jeontent of human tissues and as- ' Quemdanft. Australasian Ann. Med,. creta-Biochem. J.; 29:1851.1935. 3r Henderson, f>. A,:iN|:h|h, J. A.: The lead content ef bane in chronic Bright's disease. Australasian Ann. Med, 0:145, 1957. 4l Chwjlra, J, |,, Jr., and Harrison, H. E.: The treatment of acute feed encepha- 19. Henke; K-. ami Luharsch. O.. editors: Handbuch der spezieilen pathologischm Anatomie und Histologic. Voi. X, Vrgiftungen. Berlin, Springer. 1930. p. 9$. 20. Baumann. A.: Uher die Durchliissigkeit der? Placenta fair Blei. Arch. CenaL, 153:5^4;, 1933. SUMMARIO IN it ' Lc Concentration De P Sanguine Integra. I De Infantes Lc ingestimi le plnmh limia reprcsenUr un ser, hygienic. Un aite iRnruli iicnthi tic M'ijiic!I.i<> inv.il: nervuse es characteristic c lie pliunbismo in it.- s-r..' tardive in le :om._ J.r v. pare esser mnlto plus fre importante que lo que es noscite. Xove methodns tl reducite le incidentia de r usque nunc illus mm ha. . de maniera significative. In despeeto del prase* {rations'* de plumbo in infantes e juveniles pole rr diirante bmge penudo* d> latente typo de saturnism typo active Per cornequt Kcngnrncer rattiraismn L per demonstrar anurmalre. Hones d# plumbs in le sa.- Le litteratura concenute per plumbo resela divrrjtet a qual niveilos de plumb patientes pediatric dehe e anormalmente she.. Le presente reports coconcentration de plumbo i; infantes e juveniles sin h: venenamento per pb.n.iv divkhto* exanimate \411.n. a J3 antics Le subject'll e* gruppos sec undo a 0 menses: Grappa If 6 I e Grappa III. 4 annex a LI 0007-SWP-000005844 * d ar t ic l es 71/7 *, 1" "* 4 SUMMAiUO IN INTMUNGUA iitliamil it tn-.il rbildrcn 4.. . . F. E.. icmuim's dited !>v v. 1957. ii Concentration De Plumbo In Plasma, | Sanguine intepe, E Erythrocyte* , Be Infantes E Juveniles Lr ingestion de phimbo per juveniles con* 'anna representor un seric e frequente riseu ^ kvpeine. Un site mortalitate e un alte Imp 3itM ill- sequellas invalidante in le systema F.. mid verseuepli.iliijv- V n-nnse s characteristic del plus suet grades . > plumbismo in juveniles. In phis. eSectos " unlive in le forma de chronic nephropathias , nue esser multo plus frequents e mullo plus "7.. and latliftmil TU'Ilt Ilf indmt. partante que lo quo es generalmente rccugmite. Xove methodos therapeutic ha forsan miiaitc le incidentia de residues nerveac. sed - o m|ik - mine illos non ha alterate k- murtalitate E. 1 blutnl. , ilr nuitiera significative. hr despecto del presetitia de alte conctn- Intienes de plumbs in lor sanguine, multe O. A., of load Lrh. hig. failles e juveniles pote remaner asv mptomatic * lurante king* periodos de tempore usipie istje t utnite tv pn de satin iiivmo sr tranfnrma in le A.: U* e analv 952. ` hihlren. 5. en. b... tvpu active. Per conscipierte il es importante ", n-rognnscer satumismo latente asymptomatic . pt rienwnstrar anonnalmente alte concentra* innr* de plumbs in le sanguine. Le litteratura ccncemite con invencnamento , jrr plumho revela div ergente opiniones relative , j f|ua! nivellos de plumho in le sanguine de H. E.: | juticiitev pediatric dehe essir considerate cmno d. Pk bs - - aNtrmalmenteiaite. ^ in cfeil- Le presente rrportn concern* le studio del 8 rnucentralinn de pliunbu in te sanguine ck- 103 crmunn, Lin. d levels c clinic. sfantes e juveniles sin hisioria de pica o iniremainentoi i per phimbo. Le dates del in* . siividiKS* namiiute variava al> 5 haras usque ( a 1-1 annus. Le subjecto esseva dividit* in Ires , tptjtpos sceundo tttr etate: rott|ipu I, 5 Imras Cholalc. J aw& To*., . a 8 tnanses; Gruppo II, 8,1 menses a 4 annex; f Gmpa l!I, 4 anrics a 33 mom. Esseva empleatc un modification del iiH-thodii a dithiainui (in uso routman a iste lahuratoriu). In 82 del 103 casus, k- iimtnito dr pliimim <lc cnmpmgitc erythroevtus e del plasma csst-va determinate separaleinente. In sulmcnte 22 de isle casus, minuscule quanti tates de phiinbo (0,009 mg per 100 ml o minus) esseva truvate in le plasma. In le caso de ervthrucytos coinpiiigite It- scula del valures esseva all 0,001 a 0.144 mg per 100 ml e in le caso de sanguine integre ab 0.003 a 0.054 mg per 100 ml. Lr concentration de plumbo in le ! del 101 subjectos examinate non pareva relatioiiate a mo o racia. Le rolo dd etate esseva revelatc per le snpiente eonstatation: Le valores obtenite in Cmppol issscva-signitt* cativementc plus iwsse que le valotes obtenite in Gruppu 11 c Gmppn 111. Cnippo II e Oruppo III imNivtrava uppmximativ entente le mesme ccmtento de plumbu in sanguine integre e in erythroev tos. Le valores median in Cnippo I esseva 0,015 mg per 100 ml pro sanguine integre 0,014 mg per 1001 ml pro erythro cytes. In Gruppu 11 c Gruppo III in combina tion. le corrcv]miidcute valeres esseva 0.027 mg per 100 ml de sanguine integre e 0,085 mg per 100 ml dc- erythrocytes. Le scsk de! valuras in Gruppu I esseva ab 0,005 a 0,031 mg per 100 ml de sanguine integre e ab 0.01 a 0.09 mg per 100 ml de erv thrucyto& In Cnippo He Gruppo III in combination, le correspondente scales esseva ab 0,1X13 a 0,054 nig per 100 ml de sanguine integre e 0,003 a 0,144 tng per 100 ml de erythroev tos. Xuvanta pm cento del valurcs esseva inter 0.015 e 0,04 mg per 100 ml de sanguine integre e inter 0,028 e 0,101 mg per 100 ml dc- mthroev tm. Quantitates significative de phiinbn esseva trovate in k- caso dc neonatos in le sanguine integre (0,007 a 0.028 mg per lOtl ml) e in le erythrocytes (0,01 a 0,044 mg per 100 ml). a . b ;: and * 3. -ditort: gischen X. Ver- ` % p. 90. issigkest Gynak., I H' 0007-SWP-000005845