USMLE Iron studies in lead poisoning?

[Romborg]

There's a question in UWorld where a lead poisoning patient has normal serum iron studies. In the explanation it says "(In lead poisoning) Iron studies are normal unless co-existing iron deficiency is present as well".

Does anyone have any idea why that is? I was under the impression that - like all sideroblastic anemias - a lead poisoning patient would have increased serum iron, increased ferritin and normal to low TIBC. Goljan also lists iron studies in lead poisoning as having a sideroblastic pattern.

Any idea why UWorld says they're normal?

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[Ho0v-man]

It’s my understanding that this is a controversial topic. Sideroblastic anemia is by definition an iron overload state while you don’t have to have an iron overload state in lead poisoning. There’s a boards and beyond video in hematology I believe that covers this.

 

[Romborg]

It’s my understanding that this is a controversial topic. Sideroblastic anemia is by definition an iron overload state while you don’t have to have an iron overload state in lead poisoning. There’s a boards and beyond video in hematology I believe that covers this.

Just went over the relevant portion of the B&B videos and admittedly it does a job of pointing out that this is indeed a controversial topic - which is more than what most of the other resources bothered with - and why it'd be easier to view lead poisoning and sideroblastic anemias as separate disorders to avoid confusions based on iron studies and FEP levels.

However the fact that Goljan lists lead poisoning specifically, and not just sideroblastic anemias in general, as having an iron overloaded pattern of iron studies when B&B contradicts this entirely (claiming they're normal to low) doesn't fill me with much confidence. But then again I guess that's why its controversial.