Lead Exposure in Preterm Infants Receiving Packed Red Blood Cell Transfusions
Authors: Abu Seif Ibrahim S H , Yosef Mustafa M M , Saadoun Noha E M , Barakat Noha M 
Published: November 2024

Abstract

Background
The frequency of anemia is high in very low birth weight (VLBW) infants in the neonatal intensive care units (NICU). Blood transfusion has been associated with significant morbidity among which what is related to the increased lead content of blood.

Aim of the Work
To evaluate pre- and post-transfusion serum lead level in preterm neonates with birth weight of 1500 grams (VLBW) receiving packed red blood cells (PRBCs) transfusions and correlate these levels to lead concentrations in the transfused PRBCs and to evaluate effect of environmental prenatal maternal exposure to lead on neonatal serum lead level.

Methods
This a prospective cohort study and was conducted on 45 preterm infants who were admitted to NICUs of Ain Shams university hospitals. All selected neonates were subjected to full maternal, natal and postnatal history, full clinical evaluation, laboratory investigations including measurement of serum lead level, hemoglobin and hematocrit pre and post-transfusion. By using the 2010 Centers for Disease Control and Prevention (CDC) guidelines for identification of lead exposure in pregnant and lactating women, studied mothers who met one of these criteria (Living near lead mines, smelters or battery recycling plants, working with lead, use lead glazed ceramic pottery, renovating or remodeling older homes without lead hazard controls, using imported cosmetics or certain food may be contaminated with lead, eating nonfood substances (pica) contaminated with lead, and/or consumption of lead contaminated drinking water) were considered at risk of environmental exposure to lead

Results
Twenty-three of studied infants (51.1%) were females, and 22 (48.9%) were males. Their gestational ages were ranged between 27 to 33 weeks with mean ± SD: 29.91± 2.03 weeks and their weights ranged between 700 to 1500 grams with mean ± SD: 1228.4 ± 222.16 grams. Regarding pretransfusion hematological parameters, the mean hemoglobin (Hb) concentration was 7.2 ± 1.5 g/dl and the mean hematocrit (HCT) percent was 28.9 ± 5.05%. while, post-transfusion mean Hb concentration was 11.2 ± 1.3 g/dl and the mean HCT was 38.4 ± 4.8%. Pretransfusion serum leads levels ranged between 0.3 to 23 pg/L with median (IQR): 4.7 (0.71 - 1.8) pg/L. While post-transfusion lead levels ranged between 0.6 - 20 7 pg/L with median (IQR): 7 (0.89 - 2.4) pg/L. The post-transfusion lead level was significantly higher than the pre-transfusion lead levels with p-value: 0.009. There was a significant correlation between the increase in posttransfusion lead level and lead levels in transfused PRBCs. Regarding prenatal maternal lead exposure, 29 (64.4%) of mothers showed positive history of lead exposure (17 mothers were working in lead, 10 mothers were using cheap and unknow cosmetics, 10 were using Ceramic utensils) while 16 (35.6%) showed no history of lead exposure, there was no statistically significant difference between infants with history of environment prenatal maternal lead exposure and those without regarding gestational ages, weight, pre-transfusion Hb concentration, Hematocrit and serum lead levels.

Conclusion
Blood transfusions is a source of lead and therefore, it should be considered when administering blood transfusions to infants, particularly to very preterm babies.