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Peripheral blood film from an anemic 53-year-old geophysicist who complained of fatigue and constipation. The blood film of hisasymptomatic wife showed similar changes, but that of his 12-year-old son was normal.
Basophilic stippling of this patient’s red cells (image below, arrows) suggested lead poisoning. Despite repeated inquiry,however, no source for such poisoning emerged. The plot thickened when blood lead concentrations were substantially elevated in both the man and his wife butnormal in their son. Continued sleuthing ultimately unveiled the culprit — cocktail glasses decorated with lead-based paint. The husband and wife drankfrom these glasses daily, but their son never drank from them. Washing the glasses by machine presumably caused leaching of lead salts. Chelation therapyfor the two adults returned their hematologic findings to normal, and the patient became asymptomatic.
Moral: Basophilic stippling of red cells can be the first, best, or only clue to lead poisoning.
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