D

Lead inhibits δ-ALA dehydratase and ferrochelatase, producing a microcytic, sideroblastic anemia with basophilic stippling; urinary porphyrin abnormalities (chiefly coproporphyrin) are also seen. It does not produce macrocytic anemia, making option D the exception [Papanikolaou et al., 2005, PMID 16192916; Cohen et al., 1981, PMID 7232054].