Relation between Blood Lead Levels and Hypochromic Microcytic Anemia among Primary School Children

Iron deficiency (ID) and thalassemia are the main causes of hypochromic microcytic anemia (HMA), a common nutritional disorder affecting school-age children. This study compared Group A, hypochromic microcytic children with ID, Group B, hypochromic microcytic children with normal ferritin levels, and control groups to investigate the additional effect of lead exposure on the severity of HMA in children aged 9–12 years. Blood analyses showed that Group A had higher blood lead levels (BLLs) (7.764 μg/dL) and significantly lower iron parameters (serum iron 47.82 ± 3.15 μg/dL and ferritin 14.41 ± 1.329 ng/mL) than controls (86.86 ± 3.003 μg/dL iron, 72.9 ± 5.847 ng/mL ferritin, and 3.175 ± 0.5347 μg/dL BLL; all P < 0.0001). Group B exhibited moderate in comparison to Group A lead exposure (7.54 ± 1.15 μg/dL) and iron-replete but elevated ferritin (118.6 ± 60.75 ng/mL). Lead interferes with iron metabolism, as evidenced by the negative correlation between lead levels and iron status (serum iron r = −0.2281, transferrin saturation r = −0.3141) and the positive correlation with total iron binding capacity (r = 0.32). While Group B children maintain different iron profiles despite similar lead exposure, the results show that environmental lead exposure exacerbates ID in Group A through disrupted absorption and utilization. These findings highlight the importance of concurrent lead screening and iron status evaluation in pediatric HMA management, especially in areas with environmental lead contamination.