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Sandra M. Stewart-Pinkham, MD
Columbus, Ohio

JAMA. 1988;259(8):1182.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.

—Regarding the article by Yip et al¹ on the declining prevalence of anemia, I believe it is important to recognize that a decline in lead exposure from leaded gasoline occurred during the same time period, reflected in a significant decrease in blood lead levels. Lead is an antimetabolite of copper, essential for the utilization of iron. This decreased exposure is a factor that would affect all socioeconomic groups.

Although there is decreased exposure to lead, there is increasing exposure to cadmium. Cadmium rarely causes anemia, but it does cause intravascular hemolysis and increased osmotic fragility. The hematocrit may be on the low side of normal. Because cadmium in the gastrointestinal tract blocks the uptake of vitamin B₁₂, mild macrocytosis may be seen as well as a slight increase in reticulocytes and a slight decrease in the red blood cell count.

The Special Supplemental Food Program . . . [Full Text PDF of this Article]

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