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Mercury Content of Blood Transfusions for Infants With Extremely Low Birth Weight

OBJECTIVES: To assess whether blood transfusions for infants with birth weights of 1000 g or less are a source of mercury and whether any mercury delivered through the transfusion is above the currently set oral reference dose. PATIENTS AND METHODS: We studied an observational cohort. Inclusion criteria included birth weight 1000 g or less and receipt of 1 or more packed red blood cell transfusions. Packed red blood cell units were tested prospectively for mercury levels. The quantity of transfused mercury was calculated on the basis of transfused volume and packed red blood cell mercury level. The resulting mercury level was compared with the reference dose as set by the Agency for Toxic Substances and Disease Registry, the World Health Organization, and the US Environmental Protection Agency. RESULTS: Thirty-seven infants (birth weight: 736 ± 157 g; gestational age: 25.5 ± 1.5 weeks) met the inclusion criteria. A total of 325 transfusions from 49 packed red blood cell units were administered. Mercury was detected in 40 units. The average mercury level in a packed red blood cell unit was 1.9 ± 2.6 μg/L (median: 0.9 μg/L [interquartile range: 0.3–2.5]). None of the infants received any mercury above the reference dose set by the Agency for Toxic Substances and Disease Registry and the World Health Organization. Twelve infants received 1 transfusion, and 5 infants received 2 transfusions above the Environmental Protection Agency reference dose during their entire hospitalization. CONCLUSIONS: Packed red blood cells are a source of mercury for infants. However, the amount delivered is low compared with currently set safety levels. The episodes in which mercury intake exceeded the reference dose were rare. However, without long-term follow-up, no conclusions can be made about the cognitive implications of these episodes.