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Mercury, lead, and cadmium exposure via red blood cell transfusions in preterm infants
Alison J Falck1, Alexandre E Medina2, Justine Cummins-Oman2
1Division of Neonatology, Department of Pediatrics, University of Maryland School of Medicine, 110 South Paca, 8th Floor, Baltimore, MD, 21201, USA. afalck@som.umaryland.edu.
Insights
Preterm newborns receiving packed red blood cell (PRBC) transfusions are exposed to concerning levels of mercury and lead. Prescreening donor blood can mitigate this heavy metal exposure risk.
Area of Science:
- Neonatal Medicine
- Toxicology
- Pediatric Hematology
Background:
- Developmental neurotoxicants mercury, lead, and cadmium pose risks to newborns.
- Preterm infants requiring packed red blood cell (PRBC) transfusions may receive neurotoxic doses of heavy metals.
- This study investigates the link between donor factors and heavy metal exposure in infants.
Purpose of the Study:
- To determine if preterm infants exposed to PRBC transfusions receive neurotoxic doses of mercury, lead, and cadmium.
- To explore the relationship between donor concentration, number of donors, number of transfusions, and infant exposure to these metals.
Main Methods:
- Analyzed single-donor PRBCs for mercury, lead, and cadmium concentrations.
- Calculated dose per transfusion and compared it to intravenous reference doses (IVRfDs).
- Utilized linear regression to correlate donor and infant exposure.
Main Results:
- All three metals were detected in over 95% of donor PRBCs.
- Intravenous reference doses (IVRfDs) were exceeded for mercury (8.6%) and lead (38%) in transfusions.
- Increased number of donors correlated with cumulative heavy metal dose and exceeding lead IVRfDs.
Conclusions:
- Preterm infants are exposed to significant levels of mercury and lead via PRBC transfusions.
- Cadmium exposure did not present a risk.
- Prescreening donor blood is recommended to reduce heavy metal exposure in vulnerable infants.
Background:
Mercury, lead, and cadmium are developmental neurotoxicants. We predict that preterm newborns requiring packed red blood cell (PRBC) transfusions may be exposed to neurotoxic doses. We explored the relationship between donor concentration, number of donors, number of transfusions and mercury, lead and cadmium exposure.
Methods:
Single-donor PRBCs were analyzed for mercury, lead and cadmium concentration. Dose per transfusion was calculated and compared to intravenous reference doses (IVRfDs). Linear regression analyses were performed to correlate donor and infant exposure.
Results:
Thirty-six infants received 268 transfusions from 94 donors. Number of donors and transfusions were significantly correlated with birthweight and gestational age. All three metals were detected in ≥95% of donor PRBCs. Number of donors was significantly associated with cumulative dose, and there was a significant correlation between mercury and lead doses/transfusion. IVRfDs were exceeded for mercury and lead in 8.6% and 38% of transfusions, respectively. None exceeded the IVRfD for cadmium. For lead, infants exposed to three donors had more transfusions exceeding IVRfD than those exposed to 1-2 donors.
Conclusions:
Preterm infants are exposed to heavy metals via transfusions. Doses exceeded the IVRfDs for mercury and lead. Cadmium did not pose a risk. Prescreening donor blood could reduce exposure risk.
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