Lead Content of Blood Transfusions for Extremely Low-Birth-Weight Infants

Abstract

Objective Our objective was to evaluate the levels of lead in blood transfusions for extremely low-birth-weight (ELBW) infants and how they compare with lead levels suspected of causing neurotoxicity.

Study Design This prospective cohort included infants with a birth weight ≤ 1000 g. The quantity of transfused lead was calculated based on transfused volume and packed red blood cell (PRBC) unit lead levels. The results were compared with the exposure reference.

Results Thirty-seven infants (birth weight 736 ± 157 g, gestational age 25.5 ± 1.5 weeks) received 322 transfusions from 47 PRBC units with 6.5 ± 3.5 different units used to complete all transfusions per infant. Lead was detected in all units. The average lead level in a PRBC unit was 18.3 ± 10.4 µg/L. Of 322 transfusions, 139 (43%) had lead volumes that exceeded the exposure reference. All infants received at least one transfusion with a lead volume exceeding the daily reference dose equivalent, and four infants (11%) received several transfusions with a cumulative lead volume exceeding the weekly reference dose.

Conclusion Blood transfusions are a potential source of lead for ELBW infants with unknown safety implications in this critical time of brain development.

Keywords

lead - blood transfusions - infants - PRBC

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