The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지

A case of sideroblastic anemia caused by lead-containing herbal medication

납 함유 한약환에 의한 철적모구빈혈(sideroblastic anemia) 1예

  • Park, Hyun-Sik (Department of Internal Medicine, KonKuk University School of Medicine) ;
  • Kim, Sung-Young (Department of Internal Medicine, KonKuk University School of Medicine) ;
  • Cho, Jin-Hee (Department of Laboratory Medicine, KonKuk University School of Medicine) ;
  • Moon, Hee-Won (Department of Laboratory Medicine, KonKuk University School of Medicine) ;
  • Yoon, So-Young (Department of Internal Medicine, KonKuk University School of Medicine) ;
  • Cho, Yo-Han (Department of Internal Medicine, KonKuk University School of Medicine) ;
  • Lee, Mark Hong (Department of Internal Medicine, KonKuk University School of Medicine)
  • 박현식 (건국대학교 의학전문대학원 내과학교실) ;
  • 김성용 (건국대학교 의학전문대학원 내과학교실) ;
  • 조진희 (건국대학교 의학전문대학원 진단검사의학교실) ;
  • 문희원 (건국대학교 의학전문대학원 진단검사의학교실) ;
  • 윤소영 (건국대학교 의학전문대학원 내과학교실) ;
  • 조요한 (건국대학교 의학전문대학원 내과학교실) ;
  • 이홍기 (건국대학교 의학전문대학원 내과학교실)
  • Received : 2009.09.04
  • Accepted : 2009.10.20
  • Published : 2010.10.01
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Abstract

Although lead intoxication is commonly mentioned as a cause of sideroblastic anemia, no well-documented case exists in the literature. We encountered a patient with sideroblastic anemia caused by lead-containing herbal medicine. A 34-year-old woman was admitted to our hospital with abdominal pain. She had taken herbal medicine for her general health. Anemia, hyperbilirubinemia, and elevated lactic dehydrogenase were found from the laboratory data. Bone marrow biopsy showed pathological ringed sideroblasts. Her serum level of lead was high and the lead content of the tablet was higher than permitted. We diagnosed her with sideroblastic anemia secondary to lead poisoning caused by herbal medicine. We stopped her from taking herbal medicine and she gradually recovered from anemia.

납중독은 이차성 철적모구성빈혈의 원인으로 알려져 있으며, 아시아에서는 한약 복용이 납중독의 중요한 원인으로 여겨지고 있다. 그러나 국내에서는 한약으로 인한 이차성 철적모구성빈혈의 발표가 없었다. 저자는 복통과 빈혈을 주소로 내원한 34세 여자 환자에 대해 혈청 납농도 및 복용하였던 한약의 납함량 조사를 통해 이차성 철적모구성빈혈을 진단하였고, 한약 복용 중지 후 특별한 치료없이 범혈구 감소가 서서히 회복된 증례를 경험하였기에 이를 보고한다.

Keywords

References

  1. Koh SH, Cho MG, Yoon DY, Park YS, Jung KS, Park KC, Ryu JS, Cho HC. Case of isoniazid-induced sideroblastic anemia. Korean J Med 42:699-702, 1992
  2. Forman WB, Sheehan D, Cappelli S, Coffman B. Zinc abuse: an unsuspected cause of sideroblastic anemia. West J Med 152: 190-192, 1990
  3. Dacie JV, Doniach I. The basophilic property of the iron-containing granules in siderocytes. J Pathol Bacteriol 59:684-686, 1947 https://doi.org/10.1002/path.1700590421
  4. Rundles RW, Falls HF. Hereditary (sex-linked) anemia. Am J Med Sci 211:641-658, 1946 https://doi.org/10.1097/00000441-194606000-00001
  5. McFadzean AJ, Davis LJ. Iron staining erythrocyte inclusions with special reference to acquired haemolytic anemia. Glsgow Med J 28:237-279, 1947
  6. 대한혈액학회. 혈액학. 초판. p. 85, 서울, 이퍼블릭, 2006
  7. Alcindor T, Bridges KR. Sideroblastic anemias. British Journal of Haematology 116:733-743, 2002 https://doi.org/10.1046/j.0007-1048.2002.03378.x
  8. Pagliuca A, Mufti GJ, Baldwin D, Lestas AN, Wallis RM, Bellingham AJ. Lead poisoning: clinical, biochemical, and haematological aspects of a recent outbreak. J Clin Pathol 43: 277-281, 1990 https://doi.org/10.1136/jcp.43.4.277
  9. Kim JY, Kim JH, Kim HW, Roh JH, Lee KH, Cheon BC, Nam SM. A review of lead poisoning cases reported for recent 30 years in Korea. Korean J Med 66:617-624, 2004
  10. Oh SW. The study on heavy metal contamination of traditional drugs (Herbpills). p. 6-40, Research Laboratory, Korean Medical Association, 1983
  11. Fischbein A, Hu H. Occupational and environmental exposure to lead. In: Rom WN, Markowitz SB, eds. Environmental and occupational medicine. 4th ed. p. 958, Philadelphia, Wolters Kluwer/ Lippincott Williams & Wilkins, 2007