Lead exposure from blood transfusion to premature infants

Objective: The objective of this study was to determine the exposure of premature infants to lead from blood transfusions. Study design: Blood led concentrations were determined for 19 very premature infants at the time of admission, at 4 weeks of life, and before and after transfusions and in the donor packed red blood cells of 79 transfusions. Results: The number of transfusions per patient was 4.2 +/- 2.8 (mean +/- SD) with 15.7 +/- 1.9 mL/kg packed red blood cells for a lead dose of 1.56 +/- 1.77 mug/dL. The total dose of lead from these transfusions over the 4-week period was 4.0 +/- 2.8 mug/kg (range, 0.9-10.6 mug/kg). Increases in post-transfusion blood lead concentration were linear with doses higher than 1.5 mug/dL. Packed red blood cells with a blood lead concentration of greater than or equal to5 mug/dL resulted in an elevated post-transfusion blood lead concentration in some infants. Conclusions: The lead exposure to these infants through blood transfusion exceeds the acceptable daily intake values for lead and may result in unacceptably high post-transfusion blood lead concentrations. Use of packed red blood cells with lead concentrations <3.3 <mu>g/dL is one cost-effective means to reduce exposure.