[Lead poisoning diagnosed in a patient with anemia accompanied by abdominal pain]

A 31-year-old man presented with abdominal colic, lumbago, shortness of breath on exertion, and nausea that had begun one month earlier. Imaging and endoscopic findings were unremarkable, but the patient was referred to a hematologist due to detection of normocytic anemia. Blood tests showed increased reticulocytes with a pattern of impaired iron utilization. Bone marrow examination revealed erythroid hyperplasia with a predominance of type II-III sideroblasts. However, the dysplasia remained mild, and no chromosomal abnormalities were observed. Further workup was conducted based on the patient's occupational history as an auto mechanic and the characteristic abdominal symptoms. This revealed a significant increase in blood free protoporphyrin and urinary δ-aminolevulinic acid levels as well as an elevated blood lead concentration (71.8 µg/dl), leading to a diagnosis of lead poisoning. Symptoms improved with chelation therapy. Lead poisoning is caused by oral or respiratory ingestion of lead present in paint, ceramics, batteries, and other products. Anemia, abdominal pain, and neurological symptoms are the three main symptoms, but irreversible encephalopathy and renal dysfunction may develop in severe cases. It is important to consider lead poisoning as a differential diagnosis in cases of unexplained abdominal pain and anemia.