Proponents of serial plasma or serial blood donation (e.g. bloodletting) to reduce the total body burden of polyfluoroalkyl and perfluoroalkyl (PFAS/PFOS) compounds may cite what data to support their claim? How might this affect questions posed to clinical toxicologists and poison control centers?
In a recently published randomized controlled trial among firefighters with a baseline perfluorooctane sulfonate (PFOS) level of > 5ng/mL or more, participants either a) donated plasma every 6 weeks, b) donated blood every 12 weeks, or c) were observed. The authors measured PFOS levels after one year of study and concluded that serial donation led to decreased serum PFOS levels. Unfortunately, the study was limited in that it did not evaluate for rebound levels after cessation of bloodletting, did not demonstrate any clinically meaningful outcome, and failed to assess long term harm. Though the authors conclude that further research is needed to understand clinical implications, many news organizations and advocacy groups have mistakenly interpreted the results of the RCT and may conclude that serial blood donation has merit.
Regional poison centers should be aware of these RCT results and prepared to answer questions about occupational and environmental PFAS/PFOS exposures and treatment.
Gasiorowski R, Forbes MK, Silver G, Krastev Y, Hamdorf B, Lewis B, Tisbury M, Cole-Sinclair M, Lanphear BP, Klein RA, Holmes N, Taylor MP. Effect of Plasma and Blood Donations on Levels of Perfluoroalkyl and Polyfluoroalkyl Substances in Firefighters in Australia: A Randomized Clinical Trial. JAMA Netw Open. 2022 Apr 1;5(4):e226257. doi: 10.1001/jamanetworkopen.2022.6257. PMID: 35394514; PMCID: PMC8994130.
Contributed by: Joseph Kennedy, MD
University of Vermont Medical Toxicology