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The Porphyrin Content of Individual Erythrocytes

Steven B. Markowitz, MD; Carol M. Nunez, RN, BSN; Susan Klitzman, DrPH; Abdulrehman A. Munshi, PhD, DrPH; Woo Sup Kim, MD; Josef Eisinger, PhD; Philip J. Landrigan, MD

JAMA. 1994;271(12):932-934.

Abstract
A 45-year-old Korean man developed abdominal colic, muscle pain, and fatigue. Following a 3-week hospitalization, acute intermittent porphyria was diagnosed based on the symptoms and a high level of urinary -aminolevulinic acid (378 µmol/L [4.95 mg/dL]). However, discovery of an elevated blood lead level (3.7 µmol/L [76 µg/dL]) subsequently led to the correct diagnosis. No occupational source of lead exposure was identified. The patient reported ingesting a Chinese herbal preparation for 4 weeks prior to becoming ill. A public health investigation revealed that the source of lead exposure was hai ge fen (clamshell powder), one of the 36 ingredients of the Chinese herbal medicine. We used fluorescence image—based cytometry to determine the frequency distribution of the zinc protoporphyrin content in circulating red blood cells and found that 70% of the patient's cells contained elevated levels of zinc protoporphyrin, consistent with the duration of lead exposure and effect of lead on heme synthesis. Analysis of zinc protoporphyrin content in circulating red blood cell distributions may be useful in the diagnosis, therapy, and kinetic modeling of lead poisoning. Environmental lead poisoning is best addressed through the close collaboration of clinicians, public health specialists, and laboratory scientists.

(JAMA. 1994;271:932-934)

Author Affiliations
From the Division of Environmental and Occupational Medicine (Drs Markowitz and Landrigan) and Department of Physiology and Biophysics (Dr Eisinger), Mount Sinai School of Medicine, and the New York City Department of Health (Drs Klitzman and Munshi and Ms Nunez), New York, NY. Dr Kim is in private practice in Queens, NY.

Footnotes
Reprint requests to Mount Sinai School of Medicine, Box 1057, 1 Gustave L. Levy PI, New York, NY 10029 (Dr Markowitz).

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