What are the steps to diagnosing lead poisoning?

Question

Let's say a patient presents with fatigue, headaches, gout, aggression, memory loss, sleep disturbance, tremor, slow nerve conduction, and ED. After running a CBC and finding microcytic anemia and leukocytosis, how probable is it that a doctor would say "definetly lead poisoning" BEFORE looking at the urine and finsing sediment, or doing a renal biopsy? People actually in the medical field please help me out? I'm reseaching for my short story and I like to be accurate.

Answer 1

So, the first thing I would do if I saw symptoms consistent with lead exposure is take a very good history - for example: how old is the patient's house (does he have lead based paint on the walls)? What is his water source - i.e. does he have lead contamination in the water/soil? What kind of work does he do - is there occupational exposure? If those questions indicated a possible exposure, then I would order some lab tests - CBC to look for microcytic, hypochromic anemia. A peripheral smear of the blood may show basophilic stippling, (helpful but not limited just to lead poisoning). Based on your symptoms, it sounds like the patient would have had long term exposure to lead, so you could get a blood lead level. Also, in September the FDA approved a new test called the LeadCare II Blood Lead Test System - its done on a sample of venous blood, and results are back in a few minutes.

I don't think a renal biopsy or urine examination is necessary for the diagnosis, BUT I am not an expert on the kidney.

Sounds like an interesting story - good luck!