Lead: a hidden “untested” risk in neonatal blood transfusion

Aly, Sanaa M.; Omran, Ahmed; Abdalla, Mohamed; Gaulier, Jean-Michel; El-Metwally, Dina

doi:10.1038/s41390-018-0175-9

Cited by 4 publications

(5 citation statements)

References 31 publications

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“…While the presence of HMs in donor blood used for transfusions in NICUs has been reported previously [ 24 , 25 , 28 , 29 ], this is the first report of multiple HM exposure in neonates via different blood transfusion products, based on inductively coupled plasma mass spectrometry (ICP-MS) assays. The aims of the study were to (i) determine the levels of tested HMs (Pb, Hg, and Cd) in various blood products (plasma, platelets, pRBCs, and WB), which are used in neonatal blood transfusion; (ii) explore the probability of concurrent exposure to different HMs; (iii) identify the expected HMs’ load/transfusion versus the anticipated safe values; and (iv) assess the risks of transfusion.…”

Section: Introductionmentioning

confidence: 83%

“…The adult donors may be exposed to a variety of substances, including HMs from either environmental or occupational sources [ 23 ]. Neonates are one of the most vulnerable groups to such exposures because they are the most frequent recipients of transfused blood [ 24 , 25 , 26 ]. Safe levels for intravenous administration of these metals are unknown [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

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Lead, Mercury, and Cadmium Concentrations in Blood Products Transfused to Neonates: Elimination Not Just Mitigation

Aly,

Elfiky,

Mohamed

et al. 2023

Toxics

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Lead (Pb), mercury (Hg), and cadmium (Cd) are identified as potent developmental neurotoxicants. Neonates are the main group receiving multiple blood transfusions. The exposure of neonates to these heavy metals (HMs) can occur through blood transfusions. This study aimed to determine the concentrations of lead (Pb), mercury (Hg), and cadmium (Cd) in various blood products (plasma, platelets, packed red blood cells (pRBCs), and whole blood (WB)) to explore the probability of concurrent exposure of these HMs and to identify the metal load per transfusion with risk assessment. Residual bloods from blood bank bags were collected after neonatal transfusion. Pb, Hg, and Cd concentrations were determined in 120 samples of blood products by inductively coupled plasma mass spectrometry (ICP-MS). Pb and Cd levels were over the normal levels in 19.2 and 5.9% of all blood units, respectively. In 35 and 0.8% of blood units, the Pb and Cd concentrations, respectively, were higher than that recommended for transfusions in premature neonates. The anticipated safe value was surpassed by 2.5% for Cd of all transfusions, primarily because of WB. However, Hg was detected only in 5.8% of all samples and their concentrations were within the normal range. The concurrent neonatal exposure to Pb, Hg, and Cd was statistically significant. Hazard quotients of Hg and Cr were >1 and Pb cancer risk was 2.41 × 10−4. To the best of our knowledge, this study is the first report examining Pb, Hg, and Cd in blood products other than WB and pRBCs using ICP-MS. This study demonstrated the exposure of neonates to Pb, Hg, and Cd during transfusion with a considerable amount of Pb. It confirms the significant concurrent exposure to the three HMs, which maximize their potential developmental neurotoxicity with a high probability of developing non-carcinogenic and carcinogenic health effects.

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Section: Introductionmentioning

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Lead, Mercury, and Cadmium Concentrations in Blood Products Transfused to Neonates: Elimination Not Just Mitigation

Aly,

Elfiky,

Mohamed

et al. 2023

Toxics

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“…Therefore, it is necessary to provide blood donation resources as well as provide healthy blood and prevent blood loss 2–4 . In addition to the health of the blood donor, the maintenance and storage of blood products are also important 5–8 …”

Section: Introductionmentioning

confidence: 99%

“…[2][3][4] In addition to the health of the blood donor, the maintenance and storage of blood products are also important. [5][6][7][8] Preparing the blood component and storing in ex vivo causes storage complications, which are referred to as "storage lesion." The lack of attention to this issue can lead to complications of blood transfusion.…”

Section: Introductionmentioning

confidence: 99%

Use of antioxidant nanoparticles to reduce oxidative stress in blood storage

Barzegar

Kojabad

Shabestari

et al. 2021

Biotech and App Biochem

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Oxidative damage by free radicals has a negative effect on blood quality during storage. Antioxidant nanoparticles can prevent oxidative stress. We use SOD-CAT-Alb-PEG-PLGA-nanoparticles to reduce the effects of oxidative stress in blood storage. Electrospray was employed to prepare nanoparticles. Nanoparticles entered the test bags and were kept for 35 days from the time of donation under standard conditions. On target days, experiments were performed on the samples taken. The examination included blood smear, red blood cells count, hemoglobin, hematocrit, K, Fe, glutathione peroxidase, glutathion reductase, glucose-6-phosphate dehydrogenase, prooxidant-antioxidant balance, malondialdehyde, and flow cytometric assay for phosphatidylserine. The repeated measures analysis was performed on samples every week. Morphological changes were less in the test group compared to the control. The quantitative hemolysis profile test showed significant changes in the test and control groups (p < 0.05) in consecutive weeks except for K and Fe. Oxidative stress parameters too showed a significant change during the target days of the examination (p < 0.05

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“…5,8 Blood products including whole blood, donor packed red blood cells (PRBCs), platelets, and plasma, routinely used for neonatal transfusions, are known sources of Pb and Hg exposure to infants. 9,10 Our previous studies have shown that very premature infants at <30 weeks of gestation are exposed to the heavy metal Pb through RBC transfusions and that Pb exposure from RBC transfusion may exceed established safety limits. 11,12 Prenatal exposure to Hg and Pb from intrauterine blood transfusion (IUBT) has never before been studied.…”

Section: Introductionmentioning

confidence: 99%

Fetal exposure to mercury and lead from intrauterine blood transfusions

et al. 2019

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BACKGROUND: Mercury (Hg) and lead (Pb) exposure during childhood is associated with irreversible neurodevelopmental effects. Fetal exposure to Hg and Pb from intrauterine blood transfusion (IUBT) has not been reported. METHODS: Fetal exposure was estimated based on transfusion volume and metal concentration in donor packed red blood cell (PRBCs). As biomarkers to quantify prenatal exposure are unknown, Hg and Pb in donor PRBCs were compared to estimated intravenous (IV) RfDs based on gastrointestinal absorption. RESULTS: Three pregnant women received 8 single-donor IUBTs with volumes ranging from 19 to 120 mL/kg. Hg and Pb were present in all donor PRBC units. In all, 1/8 IUBT resulted in Hg dose five times higher than the estimated IV RfD. Median Pb dose in one fetus who received 5 single-donor IUBTs between 20-32 weeks gestation was 3.4 μg/kg (range 0.5-7.9 μg/kg). One donor unit contained 12.9 μg/dL of Pb, resulting in a fetal dose of 7.9 μg/kg, 40 times higher than the estimated IV RfD at 20 weeks gestation. CONCLUSION: This is the first study documenting inadvertent exposure to Hg and Pb from IUBT and quantifying the magnitude of exposure. Screening of donor blood is warranted to prevent toxic effects from Hg and Pb to the developing fetus.

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Lead: a hidden “untested” risk in neonatal blood transfusion

Cited by 4 publications

References 31 publications

Lead, Mercury, and Cadmium Concentrations in Blood Products Transfused to Neonates: Elimination Not Just Mitigation

Lead, Mercury, and Cadmium Concentrations in Blood Products Transfused to Neonates: Elimination Not Just Mitigation

Use of antioxidant nanoparticles to reduce oxidative stress in blood storage

Fetal exposure to mercury and lead from intrauterine blood transfusions

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