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Beyond the baseline: quantification of two phosphatidylethanol homologues in whole blood by LC-MS-MS and retrospective data analysis from a National Reference Laboratory.

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Packed red blood cell transfusion affecting phosphatidylethanol concentration.

Brian G Lewis1,2, Jessica J Krueger1,2, Angela Padilla-Jones2

  • 1University of Arizona College of Medicine, Phoenix, AZ, USA.

Clinical Toxicology (Philadelphia, Pa.)
|June 2, 2026
PubMed
Summary

Blood transfusions can falsely elevate phosphatidylethanol (PEth) levels, a key biomarker for alcohol consumption. This study found that even one unit of red blood cells can iatrogenically increase PEth concentrations, impacting abstinence monitoring.

Keywords:
PEthalcohol monitoringethanol monitoringpacked red blood cell transfusionphosphatidylethanol

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Area of Science:

  • Clinical Toxicology
  • Biomarker Analysis
  • Transfusion Medicine

Background:

  • Phosphatidylethanol (PEth) is a sensitive biomarker for recent ethanol consumption, crucial for monitoring alcohol abstinence, especially in organ transplant candidates.
  • PEth is stable in stored blood products and can be transfused, potentially leading to elevated levels in recipients.

Purpose of the Study:

  • To investigate the impact of packed red blood cell transfusions on phosphatidylethanol concentrations.
  • To determine if a single unit of red blood cells can cause iatrogenically elevated PEth levels.

Main Methods:

  • Prospective observational study of 50 subjects receiving one unit of packed red blood cells.
  • Whole blood PEth concentrations were measured pre- and post-transfusion using liquid chromatography-tandem mass spectrometry.
  • Hemoglobin and hematocrit levels were also monitored.

Main Results:

  • Four subjects (8%) showed an increase in PEth from negative to positive post-transfusion.
  • Six subjects (12%) experienced an increase in PEth beyond the coefficient of variance, with one showing a significant rise.
  • No subjects exhibited a decrease in PEth beyond the coefficient of variance.

Conclusions:

  • Patients receiving blood transfusions may exhibit iatrogenically elevated PEth concentrations.
  • Interpretation of PEth results requires caution in individuals who have recently undergone blood transfusions.