Which inclusion is associated with lead poisoning?

The inclusion associated with lead poisoning is basophilic stippling. This phenomenon occurs due to the inhibition of heme synthesis, which is impacted by the presence of lead in the body. Lead interferes with the function of certain enzymes involved in this process, leading to the accumulation of ribosomal RNA in red blood cells. This accumulation manifests as small, dark blue granules seen on a stained blood smear, which are referred to as basophilic stippling.

In contrast, the other inclusions listed do not have a direct association with lead poisoning. Pappenheimer bodies are clusters of iron-containing granules that are seen in conditions like sideroblastic anemia or after splenectomy. Howell-Jolly bodies are remnants of nuclear material found in red blood cells typically seen after splenectomy or in certain hemolytic anemias. Cabot rings are very rare and are associated with megaloblastic anemia and other conditions but are not specifically indicated in lead poisoning.

Thus, the presence of basophilic stippling is a critical indicator of lead toxicity in hematologic evaluations.