PFAS and the Blood Bank -- How are they related?

Don't bust out the Optia in hopes of therapeutic PFAS level reduction apheresis just yet... however... 

What are PFAS?

Are PFAS the new asbestos? You may have heard the term "forever chemicals" before. This buzzword generally refers to PFAS or Per- and polyfluorinated alkyl substances. They are deemed to be "forever chemicals" due to their propensity to hang around in the environment for an extraordinarily long period of time, seemingly forever due to them containing a strong Carbon-Fluorine bond, which lends to their "immortality". They are easily able to leach into soil and nearby waters where they pose a health risk to life.

PFAS are found in all branches of industry from textiles, fire-fighting foam, furniture, packaging, non-stick surfaces, hydrophobic surfaces/materials, paper or cardboard coating, electronics, automotive, cables, tray liners, medical products, etc. The list goes on. We are certainly not free from PFAS exposure. 

Exposure to PFAS is known to cause deleterious effects to living beings. Originally, they were thought to be relatively harmless, however, repeated exposure to PFAS raises concentrations within the body to a toxic level. As PFAS usage in materials increased, so did the knowledge that PFAS may be more harmful that originally thought. 

PFAS exposure may cause:

  • Certain cancers, especially Kidney and Testicular. 
  • Liver disease and liver damage (may be one of the reasons Non-Alcoholic Fatty Liver Disease is increasing in the population)
  • Thyroid disease and/or dysfunction. 
  • Developmental defects in fetus
  • Fertility issues in women
  • Increase in pregnancy complications
  • Increased cholesterol levels
  • Ulcerative colitis
  • Immune system damage/dysregulation

Studies are looking into other toxic manifestations of PFAS exposure

Blood donors who have elevated serum PFAS levels are not excluded from donating blood. PFAS are everywhere, and no threshold has been given that poses an increased risk to recipients of donated blood products. Blood authorities such as AABB and FDA should continue to monitor the evidence on the possible health effects of PFASs and consider the possible implications of increased PFAS levels in blood donors.

Plasma Donation and PFAS

An interesting new study out of Australia has shown a meaningful reduction in serum PFAS levels after donation of whole blood or plasma. The study followed Australian firefighters who regularly come in contact with PFAS through their regular use of firefighting foam which harbors large concentrations of PFAS. It has been noted in the past from other studies that firefighters typically have a higher serum PFAS level than other populations. 

Throughout the year of the study, significant reduction of serum PFAS levels were observed in the firefighters who donated blood and plasma. A greater reduction of PFAS levels was seen in those who donated strictly plasma, however blood donation significantly lowered levels as well. 

This is certainly an interesting discovery, given the ubiquitous nature of PFAS and difficulty in removing them from our environment once they are already there. More studies are needed to further elucidate this effect. While removing PFAS from manufacturing as a whole is the best way to remedy the situation, this can certainly be a potential valid way for those in consistent high risk groups to lower their risk of experiencing toxic PFAS effects. 

It is worth noting that there are no suggested limits or guidelines as far as PFAS levels in plasma go. For all intents and purposes, blood or plasma from donors regardless of PFAS level is currently accepted into blood bank inventory. It will be interesting to see how, if at all, this will be handled in the future. It is also probably unlikely that transfusing units of blood or FFP from donors with elevated PFAS levels will increase the recipients levels to a toxic level, but again, further studies can help flesh this out. Perhaps regular plasma donation for manufacturing/research purposes, rather than transfusion purposes would be the best route for these populations to take.

Perhaps in the future therapeutic plasma exchange will be an indication for toxic PFAS exposure? Who knows!


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