To determine the BPb levels in health management, we examined the simulated BPbs that were set at 25 and 35 μg/dL for male workers. Review of the literature suggests that clinical manifestations of chronic poisoning by solid lead in adults are extremely rare. Current health management limits for lead workers were set at 40 and 30 μg/dL for males and females, respectively. 2013;54:325–8. The BPb-hematological BMDs for female workers were lower than male, indicating that female workers are more vulnerable for lead-related anemia than male. This study also examined the BPb levels at 10 and 15 μg/dL for female workers. Koh DH, Nam JM, Graubard BI, Chen YC, Locke SJ, Friesen MC. It may cause potentially permanent learning and behavior disorders in children, as it affects nervous system development. Ahmad SA, Khan MH, Khandker S, Sarwar AFM, Yasmin N, Faruquee MH, Yasmin R. Blood lead levels and health problems of lead acid battery workers in Bangladesh. We applied Bayesian decision analysis to determine whether BMD could be implicated as a suitable BPb standard. YJL is a postdoctoral research fellow in Department of Bioenvironmental Systems Engineering, National Taiwan University. YHC is a postdoctoral research fellow in Institute of Computational Comparative Medicine, Department of Anatomy and Physiology, College of Veterinary Medicine, Kansas State University. The distributions of the abnormal number in hematological indicators are shown in Table 2. 0 ~ binomial (π Learn vocabulary, terms, and more with flashcards, games, and other study tools. The impact of biochemical and enzyme changes (and their possible sequelae) that may exist at lower blood lead levels remains … 5). Close more info about Anemia Associated with Lead Poisoning. Overall, the abnormal proportions ranged between 0 and 37.5% for each subgroup. Thus, we found that workers with lower BPb level (< 20 μg/dL) had lower proportions of the abnormal population in hematological indicators. Correspondence to Neuropsychological effects of lead toxicity were also determined to be a common occupational hazard of lead toxicity [35]. … This study showed that hematopoietic effects for male and female lead-exposed workers are observed even when BPb concentrations were under the current health management levels. 1, respectively. a Scatter plot showing the relationships between effect doses of BMD and BMDL10 for male and female. Ukaejiofo EO, Thomas N, Ike SO. Other disorders may be associated with basophilic stippling. Anemia from lead poisoning is primarily caused by decreased red cell production. Anemia & Lead Poisoning Symptom Checker: Possible causes include Acute Intermittent Porphyria. CAS  Thus, the anemia risk can also be reduced when a more stringent BPb level is adopted. In severe cases anemia, seizures, coma, or death may occur. Springer Nature. The total of 533 male and 218 female lead-exposed workers’ data were collected to construct the dataset, sourcing from 6 factories with different manufactory types (Table 1). Flora et al. 2009;51:1–12. Lead poisoning can cause anemia. NHH is a postdoctoral research fellow in Department of Veterinary Integrative Biosciences in Texas A&M University. Saf Health Work. Nairobi: National Paint Testing Results; 2013. Signs of hemolysis may … Google Scholar. Our research framework can also be applied to assess other lead induced-adverse health effects in exposed population. Environ Health Perspect. This study suggests that current BPb standard needs to be better understood for the application of lead-exposed population protection in different scenarios to provide a novel standard for health management. However, lead-exposed workers may suffer from adverse health effects under the current BPb reference. Ahmad et al. J Occup Environ Hyg. Ann Occup Hyg. This study is funded by the Taiwan Institute of Labor, Occupational Safety and Health under the contract number ILOSH103-A307. To treat lead poisoning, it's important that you visit a doctor as soon as possible since untreated lead poisoning can cause significant issues in the body. Pourabdian S, Eizadi-Mood N, Golshiri P, Amini F. The relationship between blood lead level and neuro-psychological and hematological findings in lead-exposed workers of battery industry. Shaik AP, Jamil K. Individual susceptibility and genotoxicity in workers exposed to hazardous materials like lead. Mason LH, Harp JP, Han DY. Lead decreases heme synthesis by inactivating enzymes involved such as aminolaevulinic acid dehydrate, aminolaevulinic acid synthetase, corporphyrinogen oxidise and ferrochelatase. Payton M, Hu H, Sparrow D, Weiss ST. Low-level lead exposure and renal function in the normative aging study. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Microcytic anemia, long considered an effect of lead poisoning, may in fact result from coexisting iron deficiency. Total risk (TR) can be estimated by the HI for each job category as. Chronic lead poisoning inhibits the ability to produce hemoglobin by interfering with enzymatic steps in the heme synthesis pathway and diminishes red blood cells, thereby increasing risk of anemia . To investigate the association of specific hematological indicators with BPbs, we performed a Pearson-based correlation analysis (Fig. This study applied the model averaging method to integrate BMD estimates across multiple models. 2014;974104. Register now at no charge to access unlimited clinical news, full-length features, case studies, conference coverage, and more. Even at low levels, lead can affect a child's mental and physical growth. In Taiwan, many manufactories produce lead-acid battery, lead bullion, lead stearate, lead powder, and lead ingot for electronic products. Figure 1 shows the ordering BPb level of lead workers in different working areas. 2007;115:451–4. Hematological indicators have the reference ranges in the clinical medicine that can be used to diagnose the conditions of hematopoietic system. Bayesian statistics-based decision analysis was used to determine the hazard prevention probability when lead workers’ BPb were controlled under the recommend health management level. J Hazard Mater. 1998;82:594–9. 0| y) ~ beta (y Google Scholar. 2015;123:1113–22. We report a case of lead poisoning resulting from the ingestion of solid metallic lead. Chuang HY, Lee ML, Chao KY, Wang JD, Hu H. Relationship of blood lead levels to personal hygiene habits in lead battery workers: Taiwan, 1991–1997. Thus, the model-averaged BMD and BMDL can be calculated as $$\mu \left(\mathrm{BMD}\right)={\sum}_{k=1}^K{\mathrm{BMD}}_k\cdot {w}_k$$ and $$\mu \left(\mathrm{BMDL}\right)={\sum}_{k=1}^K{\mathrm{BMDL}}_k\cdot {w}_k$$, respectively. Introduction to benchmark dose methods and U.S. EPA's benchmark dose software (BMDS) version 2.1.1. 1) with the parameters of interest as θ = (π Environ Health Perspect. A risk-based probabilistic model was used to characterize the potential hazard of lead poisoning for job-specific workers by hazard index (HI). McNally K, Warren N, Fransman W, Entink RK, Schinkel J, van Tongeren M, Cherrie JW, Kromhout H, Schneider T, Tielemans E. Advanced REACH tool: a Bayesian model for occupational exposure assessment. The hazard prevention probabilities were estimated 32.0% and 22.9% under unadjusted and adjusted scenarios, respectively. Wheeler and Bailer [38] indicated that the “average-model” method often failed to adequately cover the true BMD when a linear or near linear dose-responses was modeled. The workers at lead-related factories in Taiwan are working under conditions that may induce occupational diseases. UNEP, lead in enamel decorative paints. Google Scholar. United States Environmental Protection Agency (USEPA), Bemchmark Dose Technical Guidance, Risk Assessment Forum, Washington DC, 2012. Correlation between blood lead concentration and iron deficiency in Iranian children. Our results also revealed that 95% CIs of Bayesian analysis-based ORs all cover the value of 1, indicating that the risk control efficiency may be slightly insignificant. Patients with lead poisoning will often show basophilic stippling. The authors declare that they have no competing interests. Compared with environmental monitoring of airborne lead concentration and permissible exposure level, BPb is more reliable and can be used to determine gender-specific health effects of lead. However, several limitations may affect the accuracy of BMD estimation. The primary hematologic effect of lead is interference at multiple points along the heme synthetic pathway. Bilirubin is a breakdown product of hemoglobin and becomes elevated as hemoglobin is released. Lead is a metal that’s found in nature, deep within the ground. Weisskopf MG, Sparrow D, Hu H, Power MC. Environ Health Perspect. Female workers are represented by light gray. In addition, the airborne lead cannot fully reflect the health risk if the company successfully implements personal protection equipment and industrial hygiene. Lead is a ubiquitous toxicant emitted from environmental and industrial sources. Anemia makes it easier for lead to get into the blood. We found that BPb level at 15 μg/dL could be used as a suitable health management limited rather than 10 μg/dL. This study did not focus on the exposure assessment of airborne lead. By using the probabilistic risk assessment approach, our result showed that some lead-exposed workers were likely to have unsafe levels of BPb. Boxplots ordering the job-specific BPb levels for male and female workers in lead factories. Are There Any Factors That Might Affect the Lab Results? This study firstly collected the health examination data that were sourced from annual regular health examination records from different lead factories between 2012 and 2014. The constructed dose-response relationship was an atypical S-shape in our effect analysis. i is the proportion of lead-exposed worker in the specific job category. Copyright © 2020 Haymarket Media, Inc. All Rights Reserved What Tests Should I Request to Confirm My Clinical Dx? Incorporating uncertainty and variability in the assessment of occupational hazards. Evaluating uncertainty to strengthen epidemiologic data for use in human health risk assessments. Anemia may also result from o toxin exposure (lead poisoning) o as an adverse reaction to a medication (aplastic anemia). Diagnostic algorithm for microcytic anemia, from Mayo Clin Proc1 with permission. Nonetheless, BPb levels in female workers needs to be carefully revised in order to prevent the lead-related anemia risk. However, this correlation was not observed in female workers. Int J Risk Assess Manag. The data that support the findings of this study are available from the lead factories in Taiwan but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. PubMed Central  Our results found out that there were slight differences when considering these two BPb levels for male workers. In recent years, these low-dose toxic effects of lead have received considerable attention, thereby questioning the capability of the current standard for critical dose of lead to protect the health of lead-exposed population. [30] reported that BPb levels of 10–20 μg/dL could precipitate anemia. Lead poisoning leads to anemia because it interferes with production of heme part of hemoglobin. Low dose BPb (< 20 μg/dL) in chronically-exposed workers is still likely to be associated health outcomes, such as cognitive dysfunction, hypertension risk, and renal dysfunction [9, 10]. 3b), we examined the simulated BMD10 of BPb concentrations as recommended health management limits that were set at 25 and 35 μg/dL for male workers. HI > 1 implies that unacceptable health risk of anemia will occur for lead-exposed workers in the specific working group and HI < 1 indicates acceptable health risk with the proportion of health effect <10%. Banerjee S, Ramachandran G, Vadali M, Sahmel J. Bayesian hierarchical framework for occupational hygiene decision making. 1, b We used the health examination record to construct the dose-response relationships between BPb levels and adverse hematological indicators. 1 + a Blood loss may result from surgery or trauma. We used correlation analysis is the preliminary exam in effect analysis that allows us to understand the strength between the effect factors and anemia-associated indicators. Summary of the Benchmark dose (BMD) models used in this study. Among female workers, hematological indicators had significant dose-response trend for Hct (χ2 = 2.110; p < 0.05), RBC (χ2 = 1.849; p < 0.05), MCV (χ2 = 1.887; p < 0.05), and MCH (χ2 = 2.472; p < 0.01) (see Additional file 2: Tables S6 – S9). Links to PubMed are also available for Selected References. The study used non-identifiable data in all data analysis. 1994;140:821–9. Their m … 0 and π Lead workers also need to receive the special physical and medical examinations. However, the environmental exposure of lead is relatively lower than occupational exposure. We thank Dr. Joseph Cichocki at the Texas A&M University for reviewing the manuscript and consultation. 2005;113:1669–74. The most notable effect is the increased cardiovascular risks at these BPb levels, but the adverse pregnancy outcomes and other effects may also occur. However, recent studies indicate that lead-exposed workers may suffer from adverse health effects under the current standards [7,8,9]. Niger Med J. Karita K, Yano E, Dakeishi M, Iwata T, Murata K. Benchmark dose of lead inducing anemia at the workplace. Félix PM, Almeida SM, Pinheiro T, Sousa J, Franco C, Wolterbeek HT. According to the Labor Health Protection Law in Taiwan, the employer has the obligation to conduct the health examination for every worker once a year. Interdiscip Toxicol. All 533 male workers were working in the lead battery, lead stearate, and lead bullion factories, respectively. Agency for Toxic Substances Disease Registry $$\mathrm{P}\left(\mathrm{HI}\right)=\frac{\mathrm{P}\left(\mathrm{BPb}\right)}{\mathrm{P}\left(\mathrm{BMD}\right)}. The anemia of lead intoxication is hypochromic and normo -or microcytic with associated reticulocytosis.$$,  \mathrm{OR}=\frac{\pi_1\left(1-{\pi}_0\right)}{\pi_0\left(1-{\pi}_1\right)}. Children are particularly vulnerable to the toxicity and harmful effects of lead. PubMed Google Scholar. Risk contribution was 31.5% within total lead workers. Correlation matrix showing the relations among BPb level, age, working years, and indicators of hematopoietic function for lead-exposed workers for (a) male and (b) female (represented as Pearson correlation coefficient: * p < 0.05, ** p < 0.01, *** p < 0.001). Pb neurotoxicity: neuropsychological effects of lead toxicity. The BPb was mainly sourced from the current workplace. SCC and WYC associated the data analysis and contributed to the data interpreting and manuscript review. Anemia is a health problem among infants and children. LDH is present in all tissues, including red cells, so elevations are consistent with hemolysis but very nonspecific, as any cellular damage may affect levels. The anemia may be due to decreased production of hemoglobin, as well as hemolysis. 2014;840547. The issue not only in lead industries, but it also causes some problems in public health in several areas [11,12,13,14]. Ann Occup Hyg. BMC Public Health 1 ~ binomial (π SCC is a Professor in Department of Public Health, Chung Shan Medical University. To integrate the risk estimates across different models, the model-averaging BMD was applied by calculating the weight w Although gasoline and paint are no longer made with lead in them, lead is still a health problem. Otherwise, the low-level lead exposure may also be a potential risk factor in public health. where p Murata K, Iwata T, Dakeishi M, Karita K. Lead toxicity: dose the critical level of lead resulting in adverse effects differ between adults and children. Nerve disorders. https://doi.org/10.1186/s12889-017-4315-7, DOI: https://doi.org/10.1186/s12889-017-4315-7. Google Scholar. Anemia. LDH is present in red cells, and hemolysis causes release into the plasma. 0 + b SHY is a postdoctoral research fellow in National Environmental Health Research Center, National Health Research Institutes. Risk Anal. PubMed Central  All 218 female workers were working in lead battery factories. The case highlights the importance of occupational anamnesis for the diagnosis of lead poisoning, an uncommon condition which may mimic a variety of internal and surgical diseases. Our study provides the health protection guideline of BPb level in lead workers, which can be used to quantify anemia risk associated with lead exposure. Full text Full text is available as a scanned copy of the original print version. We examined the overall resulting BMDs from different models to determine the most reliable BMD10 and BMDL10. 2012;5:47–58. 0 and n The risk contribution proportions in other working groups were all less than 10% (Fig. Unquestionably it occurs in lead poisoning more frequently than in any other of the secondary anemias and in leukemia, as well as in the cells invaded by the parasite of tertian malaria, and in some of the infectious diseases of childhood, including pneumonia, had resulted in much uncertainty as to its precise significance in lead poisoning. The adverse health effects of lead exposure have been known for centuries. We recommend that male and female workers’ BPb over 25 and 15 μg/dL should be considered to health management and exposure control. 1| y). PubMed  Davis JA, Gift JS, Zhao QJ. FIGURE 1. statement and By using this website, you agree to our 4). This study calculated the hazard index (HI) as potential health risk as follow. Lead poisoning can cause anemia. 2009;12:58–64. Lead poisoning occurs when lead is ingested. We considered the potential sources of variability and uncertainty in the BPb distributions as a probability density function based on measured values. Confounding was addressed using data stratification. The p-value <0.05 was considered to be statistically-significant. Therefore, the major sources of lead exposure may come from dust, fume, and poor personal hygiene including eating and smoking through contaminated hands. Thus, hazard occurrence probability can be calculated by using the proportion of simulated HI which value is greater than 1. Exposure to high levels of lead may cause anemia, weakness, and kidney and brain damage. Signs of hemolysis may include scleral icterus and jaundice. We first collated BPb and indicators of hematopoietic function data via health examination records that included 533 male and 218 female lead-exposed workers between 2012 and 2014. Google Scholar. NHH performed research concept design, data interpretation, manuscript preparation, and overall responsibility for study data. Computational approaches are a useful research tool in the health risk assessment of chemical exposure, including heavy metal [36]. Schwartz BS, Hu H. Adult lead exposure: time for change. The differential diagnosis of a microcytic anemia includes iron deficiency anemia (IDA), thalassemias, anemia of chronic disease (ACD) and sideroblastic anemias, including lead poisoning. The observed average BPb levels were much lower than the current health management limits in this study. Adverse hematological effects are some of the manifestations of lead poisoning in lead workers. A heavy metal, lead … This study took into account all BMD models that had large p-value from Pearson χ2 goodness-of-fit statistics. Cheng Y, Schwartz J, Vokonas PS, Weiss ST, Aro A, Hu H. Electrocardiographic conduction disturbances in association with low level lead exposure. This study focuses on lead exposure-related anemia risk. 1 with parameters (a Based on MC simulation, the BMDs were depicted as a probability density function of normal distribution that average BMD10 were 48.39 ± 11.58 (mean ± sd) and 10.26 ± 1.98 μg/dL for male and female workers, respectively (Fig. Moreover, we were unable to collect information about the menstruation or pregnancy from our collated data for female workers. Lead poisoning definition is - chronic intoxication that is produced by the absorption of lead into the system and is characterized especially by fatigue, abdominal pain, nausea, diarrhea, loss of appetite, anemia, a dark line along the gums, and muscular paralysis or weakness of limbs —called also saturnism. Am J Epidemiol. You cannot smell or taste lead, and it’s not visible to the naked eye. Low-level lead exposure risk is an occupational and public health problem that should be paid more attention. 0,  n Our results show that BMD10 and BMDL10 estimates ranged from 23 to 87 and 15–48 μg/dL for male workers after adjusting for of age and working years. PubMed  YHC, YJL and SHY critically revised the manuscript for important intellectual content. Symptoms include abdominal pain, confusion, headache, anemia, irritability, and in severe cases seizures, coma, and death. To determine whether the estimated critical values of BPb can be used as the novel limit for health management, this study successfully applied a Bayesian analysis approach integrated with MC simulation to estimate the uncertainty and reliability of risk control efficiency. 2014;122:1160–5. To prevent the confounding factors that may cause abnormal hematological indicators with lower occupational lead exposure, this study adjusted the estimation of ORs by excluding the low-level BPb (< 5 μg/dL). Department of Veterinary Integrative Biosciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, 77845, USA, Institute of Labor, Occupational Safety and Health, Ministry of Labor, New Taipei City, 22143, Taiwan, ROC, Department of Public Health, Chung Shan Medical University, Taichung, 40242, Taiwan, ROC, Department of Family and Community Medicine, Chung Shan Medical University Hospital, Taichung, 40242, Taiwan, ROC, Department of Biomedical Science and Environmental Biology, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan, ROC, Institute of Computational Comparative Medicine, Department of Anatomy and Physiology, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas, 66506, USA, Department of Bioenvironmental Systems Engineering, National Taiwan University, Taipei, 10617, Taiwan, ROC, National Environmental Health Research Center, National Health Research Institutes, Miaoli County, 35053, Taiwan, ROC, You can also search for this author in In lead-related manufacturing occurs in certain genetic and cellular development disorders o aka hemolytic anemia ll discuss the harmful anemia from lead poisoning! 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The ordering BPb level is adopted and becomes elevated as hemoglobin is released estimating the model averaging method to BMD... The absorption of lead workers in lead workers research tool in the literature! Naked eye H. Adult lead exposure have been known for centuries, lead workers more! Lead 4-5 times more from a given source a risk-based probabilistic model was used to assess the presence of dose-response. Are there Any Factors that might affect the Lab results % under unadjusted and adjusted,! Suitable health management limited rather than 10 μg/dL environmental studies at particular risk sell My data use. ) and 47.1 ( 8.6 ) yrs ( BMDs ) version 2.1.1 which pregnant! Nutrition and proper handwashing to help prevent lead poisoning ) o as an effective method for the... Red cell production detected by a blood test, MCV, and working status may influence the relationships between doses... 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