Mercury, lead, and cadmium exposure via red blood cell transfusions in preterm infants

• Published in: Pediatric research 2020-03, Vol.87 (4), p.677-682
• Main Authors: Falck, Alison J., Medina, Alexandre E., Cummins-Oman, Justine, El-Metwally, Dina, Bearer, Cynthia F.
• Format: Article
• Language: English
• Subjects: Baltimore; Birth Weight; Blood; Blood Donors; Cadmium; Cadmium - adverse effects; Cadmium - blood; Clinical Research Article; Donor Selection; Erythrocyte Transfusion - adverse effects; Erythrocytes; Female; Gestational Age; Humans; Infant, Newborn; Infant, Premature - blood; Lead - adverse effects; Lead - blood; Male; Medicine; Medicine & Public Health; Mercury - adverse effects; Mercury - blood; Newborn babies; Pediatric Surgery; Pediatrics; Premature babies; Premature Birth; Prospective Studies; Risk Assessment; Risk Factors; Treatment Outcome
• ISSN: 0031-3998; 1530-0447
• DOI: 10.1038/s41390-019-0635-x

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.