Hematopoietic toxicity from lead-containing Ayurvedic medications.
BACKGROUND
Millions worldwide use Ayurvedic (traditional Indian) medicines. These medications are increasingly associated with lead poisoning, often accompanied by anemia. We compared the relative hematopoietic toxicity of Ayurvedic lead poisoning with a common form of occupational lead poisoning.


METHODS
We retrospectively studied 66 adult lead intoxications: 43 published Ayurvedic cases identified in published reports by searching MEDLINE (1966 to November 2005); 4 Ayurvedic patients seen at a referral center; and 19 lead paint intoxications from the same center. We considered patients' age, gender and blood lead at presentation, and then compared the groups with respect to hematopoietic parameters.


RESULTS
Ayurvedic lead poisoning was associated with higher blood lead (p<0.001), more basophilic stippling (p<0.001), lower hemoglobin (p<0.001) and higher protoporphyrin (p<0.001). Multiple regression adjusted for blood lead and gender found Ayurvedic lead poisoning associated with a 36.2 g/L (95% CI -48.8, -23.6 g/L) greater decrement in hemoglobin (p<0.001) as compared to paint-removal poisoning.


CONCLUSIONS
Ayurvedic poisoning produces greater hematopoietic toxicity than paint-removal poisoning. Ayurvedic ingestion should be considered in patients with anemia. Ayurveda users should be screened for lead exposure and strongly encouraged to discontinue metal-containing remedies.
Kales
Stefanos N
SN
Department of Medicine, Cambridge Health Alliance, Cambridge, MA 02139, USA. skales@challiance.org
Christophi
Costas A
CA
Saper
Robert B
RB
D000328:Adult; D000740:Anemia / Q000209:etiology; D000529:Complementary Therapies; D003937:Diagnosis, Differential; D005260:Female; D006413:Hematopoietic System / Q000187:drug effects*; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007854:Lead / Q000633:toxicity*; D007855:Lead Poisoning / Q000175:diagnosis* / Q000209:etiology*; D008297:Male; D008515:Medicine, Ayurvedic; D008875:Middle Aged; D011524:Protoporphyrins / Q000378:metabolism; D012189:Retrospective Studies
D006454:Hemoglobins; D011524:Protoporphyrins; D007854:Lead