Évaluation du risque de saturnisme chez les patients ayant du plomb intracorporel et mise en place d’un suivi

Abstract : Introduction: lead poisoning is an acute or chronic occupational or domestic poisoning by lead or its derivatives, but a cause of intoxication is less known : gunshot wounds with lead ammunition. The retention of lead projectiles after gunshot wounds is common. Metallic bullets or flakes containing lead may cause lead poisoning after progressive dissolution when in contact with acidic corporal fluids (peritoneal fluid, pleural fluid, synovial fluid or CSF). As this notion is less known by practitioners, rare publications, mainly clinical cases, are published on this topic. However, these data suffer from an underestimation of its incidence, the blood lead being rarely achieved in these patients. Few of the series are published in this context. The work presented here is the assessment of the systematic monitoring of the blood lead in patients detained, more often subjected to a ballistic traumatism than in the general population! , presenting intracorporeal pellets and hospitalized in the Hospitalized Secure Interregional Unit of Bordeaux University Hospital, whatever the reason. Methods: a retrospective monocentric study was carried out on the basis of medical files of the patients presenting metallic objects of ballistic origin between May 1, 2008 and December 1, 2016. The data concern socio-demographic characteristics of the patients, circumstances of contamination, nature of the intracorporeal metallic foreign bodies, their precise location on the imagery, blood lead and their possible follow-up and any clinical and biological signs suggestive of lead poisoning were collected. Results: 22 patients, representing 1.09% of the patients hospitalized during the period of the study, were recorded, with an mean age of 47 years. One was excluded and two were unable to provide information on the date of onset of the ballistic trauma. The analysis was only descriptive according to the time elapsed since the injury. In the 4 patients who had been tested for blood lead levels less than 40 days after the ballistic trauma, only one showed clinical and biological acute lead poisoning in 7 days, with a maximum blood lead level of 1566 μg/L, and evolved to chronic lead poisoning despite double chelation and surgical extraction of lead bullet residues. In the other 3 patients, blood lead levels increased to levels <450 μg/L for the first 3 weeks and then decreased within the general population level (< 100 μg/L) without symptoms of lead poisoning. In 15 patients with intracorporeal lead for more than 40 days, blood lead levels were low (< 200 μg/L except for a patient with 225 μg/L) with an average blood lead level of 78.3 ± 51.4 μg/L. When several blood lead levels were performed, they showed a stable or decreasing rate. None showed symptoms of lead poisoning. Conclusion: after one year, unless the patient shows symptoms suggestive of lead poisoning or presents an intercurrent event that may cause a change in blood lead level, there is no need for further examination, except to have a blood lead level which will be a reference value for the follow-up of the patient. Patients with intracorporeal weights therefore require a notification in their medical file in order not to overlook a current or future risk of lea poisoning, even several years after the trauma. The goal of this follow-up is the possibility of intervening rapidly if lead poisoning develops, which can be the cause of chronic and disabling pathologies.
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Master Thesis
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Claire Masson Samoyault. Évaluation du risque de saturnisme chez les patients ayant du plomb intracorporel et mise en place d’un suivi. Médecine humaine et pathologie. 2017. ⟨dumas-01665186⟩

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