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Toxic metals exert their harmful effects through several common mechanisms, such as enzyme inhibition, disruption of subcellular organelles, and interaction with DNA, which can result in mutagenesis, apoptosis, or carcinogenesis ( Figure 1 )

Wang L, Wu Z, Xu C, Ye H

Their presence would indicate a problem with injection technique, preparation, or in rare cases, individual sensitivity that should prompt a review of the protocol and professional consultation

Seek urgent same-day assessment or call 999 for emergency care if experiencing: Severe chest pain Severe shortness of breath Fainting or collapse Acute or rapidly worsening neurological deficits (such as new limb weakness, sudden gait disturbance, or bladder/bowel dysfunction) Persistent or worsening anaemia symptoms despite treatmentincluding breathlessness, chest discomfort, palpitations, or extreme fatigueshould trigger medical review