Changes in Blood Lead Levels Caused by Retained Bullets from Gunshot Wounds

Joseph L. McQuirter, DDS and Stephen J. Rothenberg, Ph.D.
Charles R. Drew University of Medicine and Science, Los Angeles, California
R01ES10166

Background: The reduction in blood lead levels in children and adults in the U.S. is one of the major public health accomplishments over the past 20 years. Most of this drop can be attributed to the removal of lead from gasoline and paint and from public health and educational campaigns on how to limit exposure.

Lead exposure can also occur from a much more violent and sudden exposure-gunshot wounds. During the 6 year period between 1993 and 1998, an examination of emergency room records estimates that more than 475,000 people were the victims of non-fatal firearm injuries. Very little research has been dedicated to this source of lead exposure. These NIEHS researchers sought to answer the question: Is there a risk of lead poisoning when bullets or fragments remain lodged in the body? They studied the blood lead changes in 451 people who received care at a Los Angeles, CA trauma center for first-time gunshot wounds between 2000 and 2002.

Advance: The researchers found that among 365 gunshot victims with retained bullet fragments, 12 percent had blood lead levels at or above the threshold for "medical concern" three months after being shot. That level for adults is 20 micrograms/deciliter of blood. In addition, 38 percent had lead levels elevated to at least 10 micrograms/ deciliter which is the level of concern for children. Fragmentation of the bullets led to approximately 30% higher blood lead levels in subjects who suffered a bone fracture in the torso associated with the gunshot wound. The blood lead levels declined over time but the data suggest that of the 1 to 2 million gunshot survivors in the U.S., tens of thousands could unknowingly have lead levels high enough to threaten their health.

Implication: The study leaders point out that if patients' bullet fragments cannot be safely removed, there is no way to reduce chronically elevated blood lead levels. Since most of the subjects in the study were under 30 years of age, they could be carrying an additional body burden of lead for 40 years or more. The researchers recommend that gunshot victims with retained bullets have their blood lead levels monitored over time and be monitored for diseases and illnesses related to lead poisoning.

Citation: McQuirter JL, Rothenberg SJ, Dinkins GA, Kondrashov V, Manalo M, Todd AC. Change in blood lead concentration up to 1 year after a gunshot wound with a retained bullet. Am J Epidemiol. 2004 Apr 1;159(7):683-92.