Lead exposure in preterm infants receiving red blood cell transfusions

Abstract

Background: Preterm infants may inadvertently be exposed to lead from the packed red blood cell (pRBC) transfusions with almost no or very limited data available. The aim of the study was to quantify this exposure in preterm infants ≤30 wk gestational age (GA). Methods: Prospective cohort study, infants ≤30 wk GA were eligible, infants < 23 wk GA and known chromosomal diseases were excluded. Blood lead levels (BLLs) were obtained at birth, before and after each transfusion, and at discharge. BLLs were also obtained from the donor pRBC aliquot transfused. A linear mixed model analysis was done. results: Of 75 infants, 34 received a total of 126 pRBC transfusions. Each infant had an average of 3.7 transfusions. 92% of lead levels in the transfused aliquot were ≤ 5 mcg/dl, 6.8% were between 6-8 mcg/dl and 1 had a level of 56 mcg/ dl. Average total lead load was 1.3 mcg/dl. For each 1 mcg/dl increase in transfused pRBC lead level, infant's post-transfusion BLL increased by 0.20 mcg/dl (95% CI: 0.07 mcg/dl, 0.33 mcg/ dl; P = 0.002), adjusting for GA and birth weight. There was no significant increase in discharge BLLs, which were similar for both transfused and nontransfused infants. conclusion: Post-transfusion infant BLLs correlate significantly with the transfused pRBCs lead level.

A population‐based study on blood lead levels in blood donors

“…What could be the policy implications of our results for blood centers? The issue of lead exposure through blood transfusion and its importance has not been the object of many studies . However, according to these studies, blood transfusion could be a significant source of lead exposure in premature infants and young children.…”

“…To achieve lead exposure as low as possible, the authors recommended that blood units used in young children should be screened for lead concentrations less than 0.09 µmol/L. In another study, there was a strong correlation between lead content of transfused RBCs and posttransfusion BLL in premature infants …”

“…2,4,5 Results from studies suggest that blood transfusion could represent a significant source of lead exposure in infants and young children. [6][7][8][9] In a study in premature infants (<30 weeks of gestation), it was found that blood transfusion may increase BLLs by 27% resulting in unacceptable high posttransfusion BLLs. 6 The infants received in this study a mean of 4.2 transfusions.…”

“…In another study, there was a strong correlation between lead content of transfused RBCs and posttransfusion BLL in premature infants. 8 ABBREVIATIONS: BLL(s) 5 blood lead level(s); GM 5 geometric mean. According to a health risk assessment performed by Institut National de Sant e Publique du Qu ebec, the maximum level of lead in a blood donation that could safely be given to the vulnerable patients should not exceed 0.15 mmol/L.…”

Donor blood lead levels and transfusion safety in a vulnerable population

“…Well‐designed studies involving not only donors but also transfusion recipients could help answer the question. Zubairi and colleagues measured the BLL in transfused RBCs in conjunction with pre‐ and posttransfusion levels in infants less than 30 weeks’ gestational age (n = 75). They found a significant, linear relationship between the lead present in the transfusion product and the recipient posttransfusion levels.…”