Miwa S, Ishida Y, Takegawa S, Urata G, Toyoda T
Am J Hematol. 1981;11(1):99-105. doi: 10.1002/ajh.2830110112.
A 23-year-old Japanese male with severe lead intoxication accompanied by hemolytic anemia was studied. The patient had taken 12 g to lead in about a month. He had moderate hemolytic anemia (Hb 8.9 g/100 ml) with reticulocytosis ranging from 2.5 to 11.7%. Peripheral blood smear showed nucleated red cells (42/200 white blood cells) and marked basophilic stippling in the red cells. Activities of erythrocyte enzymes were either normal or increased except for pyrimidine 5'-nucleotidase (P5N) and delta-aminolevulinic acid dehydratase (ALA-D) both of which were found to be decreased, being 48.8% and 4.1% of the normal controls respectively. Erythrocyte reduced glutathione (GSH) was high (145.6 mg/100 ml RBC). Erythrocyte pyrimidine nucleotides were accumulated up to 10.2% of total nucleotides. The level of lead in peripheral blood was 112 microgram per 100 ml blood. Ca2+-Na2-EDTA was given to the patient as treatment. The level of lead in the blood decreased gradually and hemolytic anemia improved. Basophilic stippling in the red cells disappeared. These results confirmed the findings of Valentine et al [1] that lead-induced deficiency of P5N resulted in basophilic stippling and hemolytic anemia just like hereditary hemolytic anemia due to P5N deficiency.
对一名患有严重铅中毒并伴有溶血性贫血的23岁日本男性进行了研究。该患者在约一个月内摄入了12克铅。他患有中度溶血性贫血（血红蛋白8.9克/100毫升），网织红细胞增多，范围在2.5%至11.7%之间。外周血涂片显示有核红细胞（42/200个白细胞），红细胞中有明显的嗜碱性点彩。除嘧啶5'-核苷酸酶（P5N）和δ-氨基乙酰丙酸脱水酶（ALA-D）外，红细胞酶的活性正常或升高，这两种酶均被发现降低，分别为正常对照的48.8%和4.1%。红细胞还原型谷胱甘肽（GSH）含量较高（145.6毫克/100毫升红细胞）。红细胞嘧啶核苷酸积累至总核苷酸的10.2%。外周血铅水平为每100毫升血液112微克。给予患者Ca2+-Na2-EDTA进行治疗。血液中的铅水平逐渐下降，溶血性贫血得到改善。红细胞中的嗜碱性点彩消失。这些结果证实了瓦伦丁等人[1]的发现，即铅诱导的P5N缺乏导致嗜碱性点彩和溶血性贫血，就像由于P5N缺乏引起的遗传性溶血性贫血一样。
