Abstract
Objective: Very low birth weight (VLBW) infants frequently receive blood transfusions. We hypothesize that toxic metals in donor blood may pose a health risk with potential adverse neurologic effects on the developing brain of a vulnerable VLBW infant. Study design: Samples from 100 donor blood units were collected from a large urban hospital. Blood was analyzed for aluminum, arsenic, beryllium, cadmium, manganese, mercury, nickel, lead and polonium. The estimated upper limit of acceptable metal concentration in donor blood was calculated assuming a transfusion volume of 20 ml/kg and using either previously published acceptable intravenous doses or oral reference doses with a conservative estimate of 10% gastrointestinal absorption. Ingested mercury was assumed to be 95% absorbed. Results: Eight of the nine metals were detectable. Concentrations of arsenic, beryllium, cadmium, mercury and polonium were not of concern for any single blood transfusion. Concentrations of aluminum, manganese, nickel and lead exceeded the estimated upper limit of acceptable concentration in 5, 11, 4 and 26 units respectively. Of the 100 units, 31 had at least one toxic metal concentration high enough to pose a potential health risk. Conclusions: VLBW infants are exposed to heavy metals that are toxic from blood transfusion. The number of units with concerning levels of toxic metals was higher than expected. Neonatologists should be aware of this potential exposure to toxic metals from donor blood when decision is made to administer blood transfusion. Neurodevelopmental studies of toxic metal exposed infants from blood transfusion are warranted.
Highlights
Blood transfusion is a critical part of neonatal intensive care and is life saving for neonates with severe anemia or hemorrhage [1]
During the first 2 weeks of life, approximately 50% of infants weighing less than 1000g at birth will receive their first transfusion [2] and without the use of erythropoiesis-stimulating agents, 85% to 90% of Very Low Birth Weight Infants (VLBWs) infants receive blood transfusions [3,4]
VLBW infants are transfused with blood that has been donated by adults 17 years of age or older
Summary
Blood transfusion is a critical part of neonatal intensive care and is life saving for neonates with severe anemia or hemorrhage [1]. During the first 2 weeks of life, approximately 50% of infants weighing less than 1000g at birth will receive their first transfusion [2] and without the use of erythropoiesis-stimulating agents, 85% to 90% of VLBW infants receive blood transfusions [3,4]. VLBW infants are transfused with blood that has been donated by adults 17 years of age or older. These donors may have had a variety of exposures to substances including toxic heavy metals from environmental and occupational sources [8]. The federal government has codified exposure levels acceptable to adult workers and to children exposed to environmental contaminants. These exposures occur mainly via ingestion or inhalation
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