Six cases of non-occupational lead poisoning from diverse environmental exposures: diagnostic clues and therapeutic outcomes

Non-occupational lead poisoning remains under-recognized despite its preventable nature. We report a retrospective case series of six adults (mean age 65 years) diagnosed with severe environmental lead exposure (blood lead level >40 μg/dL) between 2018 and 2023. All patients presented with anemia, marked reticulocytosis (2.14–6.99%), and basophilic stippling, with diverse exposure sources including preserved eggs, lead ammunition, counterfeit tin pots, welding, dental prostheses, and tin foil offerings. Diagnosis was confirmed by inductively coupled plasma mass spectrometry. All patients received calcium disodium edetate chelation therapy. At 3-month follow-up, hemoglobin increased by a median of 22 g/L and blood lead levels decreased by a median of 60.3%. Basophilic stippling in bone marrow smears served as a critical diagnostic clue even when peripheral smears were negative. These cases highlight the need for detailed lifestyle history in unexplained anemia, distinct diagnostic criteria for environmental exposures, and strengthened consumer product regulation.