Effect of Plasma and Blood Donations on Levels of Perfluoroalkyl and Polyfluoroalkyl Substances in Firefighters in Australia

Abstract

IMPORTANCEElevated levels of blood perfluoroalkyl and polyfluoroalkyl substances (PFASs) have been associated with a range of adverse health outcomes. Firefighters have been exposed to PFASs in firefighting foams and have previously been shown to have higher PFAS levels in blood samples than the general population. No interventions have been shown to reduce PFAS levels. OBJECTIVE To examine the effect of blood or plasma donations on PFAS levels in firefighters in Australia. DESIGN, SETTING, AND PARTICIPANTS This 52-week, open-label, randomized clinical trial enrolled participants from May 23 to August 23, 2019. Participants were 285 Fire Rescue Victoria staff orcontractors with serum levels of perfluorooctane sulfonate (PFOS) of 5 ng/mL or more who were eligible to donate blood, had not donated blood in the 3 months prior to randomization, and were able to provide written informed consent. Analysis was performed on an intention-to-treat basis from May to July 2021. INTERVENTIONSFirefighters with baseline PFOS levels of 5 ng/mL or more were randomly assigned to donate plasma every 6 weeks for 12 months, donate blood every 12 weeks for 12 months, or be observed only. MAIN OUTCOMES AND MEASURESThe primary end points were changes in the serum PFOS and perfluorohexane sulfonic acid (PFHxS) levels after 12 months of plasma or blood donations or after observation only. Secondary end points included changes in serum PFAS levels from week 52 to week 64, changes in other PFASs, and changes in complete blood count, biochemistry, thyroid function, and lipid profile from screening to week 52. RESULTSA total of 285 firefighters (279 men [97.9%]; mean [SD] age, 53.0 [8.4] years) were enrolled; 95 were randomly assigned to donate plasma, 95 were randomly assigned to donate blood, and 95 were randomly assigned to be observed. The mean level of PFOS at 12 months was significantly reduced by plasma donation (-2.9 ng/mL; 95% CI, -3.6 to -2.3 ng/mL; P < .001) and blood donation (-1.1 ng/mL; 95% CI, -1.5 to -0.7 ng/mL; P < .001) but was unchanged in the observation group. The mean level of PFHxS was significantly reduced by plasma donation (-1.1 ng/mL; 95% CI, -1.6 to -0.7 ng/mL; P < .001), but no significant change was observed in the blood donation or observation groups. Analysis between groups indicated that plasma donation had a larger treatment effect than blood donation, but both were significantly more efficacious than observation in reducing PFAS levels. (continued) Key Points Question Can levels of perfluoroalkyl and polyfluoroalkyl substances (PFASs) in the blood be reduced by blood or plasma donations? Findings In this randomized clinical trial of 285 firefighters, both blood and plasma donations resulted in significantly lower PFAS levels than observation alone. Plasma donation was the most effective intervention, reducing mean serum perfluorooctane sulfonate levels by 2.9 ng/mL compared with a 1.1-ng/mL reduction with blood donation, a significant difference; similar changes were seen with other PFASs. Meaning Blood or pl...

Safety and protection of plasma donors: A scoping review and evidence gap map

“…Three controlled experimental studies (and one registration [42]) examined the effect of iron supplementation [20], donation frequency [27, 42] or collection programme [16] on donor health with a follow‐up period of 1–6 months. Finally, two studies had a longer follow‐up period (6–12 months), comparing whole blood donations, plasma donations and observation only [15], or different donation volumes [26].…”

“…Two full texts could not be retrieved [10,11]. To avoid duplication of studies, the protocol [12] and two of the registrations [13,14] of studies that are described by identified research articles [15,16] are not included in our summary. The remaining 94 research articles and 5 registrations are described below.…”

“…Most published studies (n = 88) had an observational design, of which 56 were controlled studies (including 41 cohorts [26 retrospective, 8 prospective and 7 unclear], 13 were controlled before and after, 1 case-control and 1 cross-sectional study) and 32 were uncontrolled, monitoring a group of donors before and after donation(s) (n = 19) or only after donation(s) (n = 13). Thirteen studies had a controlled experimental design (i.e., [non-]randomized controlled trials), comparing plasmapheresis donors to a nodonation control group [17,18], or blood donors [15,19]; or investigating the effect of iron supplementation [20], saline infusion [21][22][23], apheresis device or programme [16,24,25], donation volume [26] or donation frequency [27]. Of note, research articles, using two different study designs depending on the factor or outcome under study, were counted twice here and in the EGM [23,[28][29][30][31][32][33].…”

Firefighters’ exposure to per-and polyfluoroalkyl substances (PFAS) as an occupational hazard: A review

“…Historically, firefighters have been exposed to harmful chemicals from fire smoke and firefighting foams containing high levels of various PAHs and PFAS (Jalilian et al, 2019;Gasiorowski et al, 2022). Additionally, a new concern has been raised regarding firefighters' exposure to PFAS through turnout gear.…”

“…Several studies have observed the association between PFAS exposure and a range of adverse health outcomes (Graber et al, 2021). Although PFAS are potentially harmful to human health, the exact threshold at which these risks may increase has remained unknown (Gasiorowski et al, 2022). Like other chemical substances, their ability to produce adverse health effects depends on exposure circumstances, such as magnitude, duration, and route of exposure (Fenton et al, 2021).…”