Erythrocyte Protoporphyrin Screening for Lead Poisoning in Bedouin Children. A Study from Kuwait

Abstract

Screening for lead poisoning can be performed by measuring either blood lead (PbB) or a haematological indicator such as erythrocyte protoporphyrin (EP). We have screened 902 infants and children aged from 3 months to 5 years amongst those attending three primary health care centres in AI Jahra governorate of Kuwait. Blood specimens were collected by finger prick on Guthrie filter paper and the dried blood samples were mailed to the Central Laboratory of the Children's Hospital, Buffalo, USA. One hundred and eighty-four (20 per cent) had an elevated EP (greater than 50 micrograms/dl). Of those 11 had values above 159 micrograms/dl; 140 children were further tested for blood lead levels (PbB) haemoglobin, mean cell volumes, and percentage of transferrin saturation; 41 had blood lead levels greater than 25 micrograms/dl which is the current definition of elevated blood lead levels. Two children (2 per cent) were in Class IV, 17 (15 per cent) and 16 (14 per cent) were in Class II and Class III, respectively. There was a significant correlation between EP and PbB (r = 0.686; P = less than 0.001). Of 72 children with elevated EP and normal PbB, 32 were anaemic (Hb less than 11 g/dl) and 20 had iron deficiency. The role of tribal practices using lead contaminated preparations and their contribution to elevated blood lead levels is discussed.