Ann Trop Paediatr. 1985 Dec; 5(4): 207-10.

High incidence of lead poisoning revealed by erythrocyte protoporphyrin (EPP) screening in Arabian children.

Shaltout AA, Ghawaby MM, Hassan MF, Hunt MC, Fernando N, Devarajan LV, Kollberg H, Guthrie R.

The measurement of erythrocyte protoporphyrin (EPP) has been used in screening infants for undue exposure to lead. The infants were from a high risk area, Al Jahra in Kuwait, and were selected from those attending the emergency department of Al Jahra District Hospital. Dried spots of blood on Guthrie filter paper were mailed to the Central Laboratory of the Children's Hospital in Buffalo, New York. Elevated EPP values (greater than 50 micrograms/dl) were present in 63 (66%) out of 96 tests. Forty-four of the infants with elevated values were investigated further: 16 had blood lead levels above 30 micrograms/dl (1.45 mmol/l) and 12 had evidence of iron deficiency anaemia. Five infants with blood lead levels above 80 micrograms/dl (3.9 mmol/l) needed urgent chelation and in addition an 8-month-old infant with the highest EPP value (478 micrograms/dl) died of acute lead encephalopathy. We conclude that lead poisoning is a serious problem in Al Jahra, Kuwait, and that a comprehensive programme for screening and health education are urgently needed to avoid the irreversible effects of lead toxicity.