Copper is an essential element and, under conditions of overload, a toxicant. A dramatic example of copper toxicity is Wilson disease (WD), a treatable but often fatal condition that is difficult to diagnose and monitor. A method for direct measurement of free copper concentrations in serum or plasma ultrafiltrate by inductively coupled mass spectrometry was developed and validated to assist with diagnosis and monitoring WD. The method was shown to be accurate (94%-109% recoveries), linear (0.5-800 microg/dL [0.08-126 micromol/L]), and precise (coefficient of variation, < 15% over the analytic measurement range). A reference interval (0-10 microg/dL [0-1.6 micromol/L]) was determined parametrically with 137 healthy adult (20-59 years) blood donors. No statistically significant difference was observed in males (n = 69) vs females (n = 68). Free copper concentrations for patients diagnosed with WD were at least 6-fold greater than the upper limit of the reference interval before treatment but fell within the reference interval after treatment.
Objective Over the past several decades there have been numerous initiatives to limit environmental lead exposure, especially among children. Recently, the CDC accepted a series of recommendations to further expand prevention of childhood lead exposure, but these recommendations do not address lead exposure occurring via blood transfusion. We sought to facilitate further assessment of transfusion-associated lead exposure by designing a procedure to test packed red blood cells (pRBCs) prepared for transfusion. Study Design The relationship between pRBC and whole blood lead concentration was investigated in 27 samples using a modified clinical assay. Subsequently, lead concentrations of 100 pRBC units were determined. Results Our sample preparation method demonstrated correlation between whole blood lead and pRBC lead concentration (R2 = 0.82). In addition, all 100 pRBC units tested had detectable lead. The median pRBC lead concentration was 0.8 μg/dL, with a standard deviation of 0.8 μg/dL and a range of 0.2 μg/dL to 4.1 μg/dL. In addition, after only a few days of storage, approximately 25% of whole blood lead was found in the supernatant plasma. Conclusions Transfusion of pRBCs is a source of lead exposure. Here we report the quantification of lead concentration in pRBCs. Among the samples that we tested, there was a greater than 20-fold range in lead concentration. Pre-transfusion testing of pRBC units according to the method we describe or donor screening of whole blood lead and selection of below-average units for transfusion to children would diminish an easily overlooked source of pediatric lead exposure.
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