Blood donation and heavy metal poisoning in developing nations: Any link?

Long term health effects of heavy metal exposure from both occupational and environmental settings involve multi-organ toxicities including but not limited to disturbances of neurological, cognitive, and metabolic processes, immune system dysregulation, carcinogenesis and sometimes permanent disabilities. Humans are exposed to toxic metals through various sources and routes of entry. The risk of heavy metal poisoning from donor blood has been the subject of many scientific investigations. In this review we highlight how the access to a safe and adequate blood transfusion with minimal risk of toxic metals to recipients is a public health challenge, especially in developing nations. For quality assurance purposes, blood donors are screened for various blood-borne pathogens, but screening for toxic metal levels is not routine. Evidence from scientific studies used in this review lends credence to the risk of heavy metal poisoning from donors with high blood concentrations of these heavy metals. The risk of toxicity is exceptionally high in vulnerable populations such as neonates and preterm infants, as well as in pregnant women and other individuals with conditions requiring multiple blood transfusions. This is worse in developing countries where some members of the population engage in illegal refining and artisanal mining activities. In order to reduce toxic metal exposure in vulnerable populations, blood meant for transfusion in vulnerable subjects, e.g. children, should be routinely screened for heavy metal concentrations. Patients receiving multiple blood transfusions should also be monitored for iron overload and its attendant toxicities.

Toxic metal exposure as a possible risk factor for COVID-19 and other respiratory infectious diseases.

Multiple medical, lifestyle, and environmental conditions, including smoking and particulate pollution, have been considered as risk factors for COronaVIrus Disease 2019 (COVID-19) susceptibility and severity. Taking into account the high level of toxic metals in both particulate matter (PM2.5) and tobacco smoke, the objective of this review is to discuss recent data on the role of heavy metal exposure in development of respiratory dysfunction, immunotoxicity, and severity of viral diseases in epidemiological and experimental studies, as to demonstrate the potential crossroads between heavy metal exposure and COVID-19 severity risk. The existing data demonstrate that As, Cd, Hg, and Pb exposure is associated with respiratory dysfunction and respiratory diseases (COPD, bronchitis). These observations corroborate laboratory findings on the role of heavy metal exposure in impaired mucociliary clearance, reduced barrier function, airway inflammation, oxidative stress, and apoptosis. The association between heavy metal exposure and severity of viral diseases, including influenza and respiratory syncytial virus has been also demonstrated. The latter may be considered a consequence of adverse effects of metal exposure on adaptive immunity. Therefore, reduction of toxic metal exposure may be considered as a potential tool for reducing susceptibility and severity of viral diseases affecting the respiratory system, including COVID-19.

Chronic copper poisoning in beef cattle in the state of Mato Grosso, Brazil / Intoxicação crônica por cobre em bovinos de corte no Estado de Mato Grosso, Brasil

Copper is an essential micromineral in animal feed; however, when consumed in excess, it can cause liver necrosis, hemolytic crisis, hemoglobinuric nephrosis and death in cattle. Although uncommon in this species, copper poisoning occurs as a result of exacerbated supplementation, deficiency of antagonist microminerals, or previous liver lesions. An outbreak of chronic copper poisoning is reported in semi-confined cattle after supplementation with 50 mg/Kg of dry matter copper. The cattle showed clinical signs characterized by anorexia, motor incoordination, loss of balance, jaundice, brownish or black urine, diarrhea and death, or were found dead, 10 to 302 days after consumption. Of the 35 cattle that died, 20 underwent necropsy, whose frequent findings were jaundice, enlarged liver with evident lobular pattern, black kidneys, and urinary bladder with brownish to blackish content. Microscopically, the liver showed vacuolar degeneration and/or zonal hepatocellular centrilobular or paracentral coagulative necrosis, in addition to cholestasis, mild periacinal fibrosis, apoptotic bodies, and mild to moderate mononuclear inflammation. Degeneration and necrosis of the tubular epithelium and intratubular hemoglobin cylinders were observed in the kidneys. Copper levels in the liver and kidneys ranged from 5,901.24 to 28,373.14 µmol/kg and from 303.72 to 14,021 µmol/kg, respectively. In conclusion, copper poisoning due to excessive nutritional supplementation is an important cause of jaundice, hemoglobinuria, and death in semi-confined cattle.(AU)

Cobre é um micromineral essencial, que quando em excesso induz necrose hepática, crise hemolítica, nefrose hemoglobínurica e morte em bovinos. As intoxicações, apesar de incomuns nessa espécie, ocorrem devido a suplementação exacerbada de cobre, pela deficiência de microminerais antagonistas ou secundária a lesão hepática prévia. Relata-se um surto de intoxicação crônica por cobre em bovinos semiconfinados após suplementação com 50mg/kg de cobre em matéria seca. Os bovinos manifestaram sinais clínicos caracterizados por anorexia, incoordenação motora, perda de equilíbrio, icterícia, urina acastanhada ou negra, diarreia e morte ou foram encontrados mortos, após 10 a 302 dias do início de consumo. De 35 bovinos que morreram 20 foram submetidos à necropsia sendo achada frequente icterícia, fígado aumentado e com padrão lobular evidente, rins pretos e bexiga urinária repleta de conteúdo acastanhado a enegrecida. Microscopicamente, no fígado havia degeneração vacuolar e ou necrose coagulativa hepatocelular zonal, centrolobular ou paracentral, além de degeneração vacuolar com corpúsculos de Councilman, colestase, fibrose periascinar leve, e inflamação de discreta a moderada. Nos rins havia degeneração e necrose do epitélio tubular assim como cilindros de hemoglobina intratubulares. Os níveis de cobre no fígado e rim foram de 5.901,24 a 28.373,14µmol/kg e 303,72 a 14.021µmol/kg respectivamente. A suplementação nutricional excessiva com cobre pode causar doença hemolítica com icterícia, hemoglobinúria e morte de bovinos mantidos em sistema de semiconfinamento.(AU)

Dermal and inhalable cobalt exposure-Uptake of cobalt for workers at Swedish hard metal plants.

PURPOSE: Cobalt exposure is known to cause adverse effects on health. A major use of cobalt is in the manufacture of hard metal. Exposure can lead to asthma, hard metal lung disease, contact allergy and increased risk of cancer. Cobalt is mainly absorbed from the pulmonary tract, however penetration through skin may occur. The relationships between exposure to inhalable cobalt in air and on skin and the uptake in blood and urine will be investigated, as well as the association between dermal symptoms and dermal exposure. METHODS: Cobalt exposure in 71 workers in hard metal production facilities was measured as inhalable cobalt in the breathing zone and cobalt found on skin with acid wash. Uptake of cobalt was determined with concentrations in blood and urine. Correlations between exposure and uptake were analysed. RESULTS: Inhalable cobalt in air and cobalt in blood and urine showed rank correlations with coefficients 0.40 and 0.25. Cobalt on skin and uptake in blood and urine presented correlation coefficients of 0.36 and 0.17. Multiple linear regression of cobalt in air and on skin with cobalt in blood showed regression coefficients with cobalt in blood (ß = 203 p < 0.0010, and ß = 0.010, p = 0.0040) and with cobalt in urine (ß = 5779, p = 0.0010, and ß = 0.10, p = 0.60). CONCLUSIONS: Our data presents statistically significant correlations between exposure to cobalt in air with uptake of cobalt in blood and urine. Cobalt on skin was statistically significant with cobalt in blood but not with urine.

Current mechanistic perspectives on male reproductive toxicity induced by heavy metals.

Environmental and occupational exposures to heavy metals have led to various deleterious damages to the biological system of which infertility is one of them. Infertility is a global public health concern, affecting 15% of all couples of reproductive age. Out of the 100% cases of reported infertility among couples, 40% of the cases are related to male factors; including decreased semen quality. This review focuses on the recent mechanistic perspectives of heavy metal-induced male reproductive toxicity. The associated toxic metal-mediated mechanisms of male reproductive toxicity include ion mimicry, disruption of cell signaling pathways, oxidative stress, altered gene expression, epigenetic regulation of gene expression, apoptosis, disruption of testis/blood barrier, inflammation and endocrine disruption. The current literature suggests that non-coding RNAs (ncRNAs) mediate paternal intergenerational epigenetic inheritance and thus has a direct functional importance, as well as possess novel biomarker potential, for male reproductive toxicity. To identify the specific ncRNAs with the most profound impacts on heavy metal-induced male reproductive toxicity should be thrust of further research.

Levels of heavy metals in soil and vegetables and associated health risks in Mojo area, Ethiopia.

Health implications to the population due to the consumption of contaminated vegetables has been a great concern all over the world. In this study, the levels of heavy metals (Cr, Cd, Zn, Fe, Pb, As, Mn, Cu, Hg, Ni and Co) in soil and commonly consumed vegetables from Mojo area in central Ethiopia have been determined using Inductively Coupled Plasma Optical Emission Spectrophotometer (ICP-OES) and possible health risks due to the consumptions of the vegetables have also been estimated. The levels of As, Pb, Cd, Zn, Cu, Hg and Co were exceeded the reference level in agricultural soil. Likewise, As, Pb, Cd, Cr and Hg levels exceeded the recommended values in vegetable samples with concentrations ranging from 1.93-5.73, 3.63-7.56, 0.56-1.56, 1.49-4.63 and 3.43-4.23 mg/kg, respectively. It was observed that leafy vegetable (cabbage) has accumulated heavy metals to greater extent compared with tomato. The estimated daily intake (EDI) of toxic metals due to the consumption of the vegetables were below the maximum tolerable daily intake (MTDI). However, the total health quotient (THQ), calculated based on EDI of the heavy metals were found > 1 for As and Hg due to tomato consumption and for As, Hg and Co due to cabbage consumption, suggesting significant health risk. The health index (HI) due to the intake of toxic metals from the consumption of both vegetables were much > 1, with HI values of 7.205 and 15.078 due to tomato and cabbage consumption, respectively. This clearly suggests the possible adverse health effect to adult population from the consumption of tomato and cabbage from the study area. The total cancer risk (TCR) analysis have also revealed the potential adverse cancer risk induced by As, Cd, Hg, and Ni from the consumption of both tomato and cabbage as their TCR values were above the threshold level. Based on the results of this study, there would be a significant health risk (both non-carcinogenic and carcinogenic) to the consumer associated with the consumption of cabbage and tomato being cultivated in Mojo area. Consequently, we recommend a strict regulatory control on the safety of vegetables originated from the study area.

Relationship between the Use of Aluminium Utensils for Cooking Meals and Chronic Aluminum Toxicity in Patients on Maintenance Hemodialysis: A Case Control Study.

BACKGROUND: Chronic aluminum toxicity (CAT) in end stage kidney disease (ESKD) patients is now a rare clinical disorder, unlike in the past, because of improvements in hemodialysis water purification systems and discontinuation of use of aluminum hydroxide as a phosphate binder. The use of aluminum utensils for cooking could be an unrecognised cause of the CAT. OBJECTIVE: To assess the association between aluminum kitchen utensils used for cooking meals and chronic aluminum toxicity (CAT) in patients on maintenance hemodialysis (MHD). MATERIAL AND METHODS: In this case control study, a total of 31 (cases n=10; controls n=21) patients on MHD for more than one year were included. Cases were defined as patients with clinical manifestations (including laboratory parameters) of CAT and high (>200 mcg/L) serum aluminum levels. Control group was chosen from the same hemodialysis facilities. Association between use of aluminum utensils for cooking and occurrence of CAT was assessed. RESULTS: The mean age of patients in the cases and the control group was 52.90 and 52.95 years respectively with on significant difference (p=0.99). There was no difference in mean duration of dialysis (p=0.78), serum calcium level (p=0.06), serum phosphate level (p=0.19), serum albumin level (p=0.06), history of hypertension (p=1.00) and history of diabetes (n=0.12) between two groups. Mean haemoglobin (p<0.05) and mean iPTH (p<0.05) was significantly lower in the cases as compared to control group. Thirteen patients had history of use of aluminum utensils [cases 10 (76.90%) and control 3 (23.10%); p<0.05]. All cases i.e. 10 (100%) had exposure to aluminum utensils whereas three (14.3%) patients in the control group had exposure to aluminum utensils whereas 18 (85.7%) patients had no exposure. The relative risk of having CAT because of use of aluminum utensils compared to not using was 28.46 (1.81 to 445.3) and the odd's ratio estimated was 120 (5.45 to 2642). CONCLUSION: Use of aluminum utensils for cooking meals is associated with CAT. Larger studies are required to confirm these findings.

Environmental exposure to cadmium-a risk for health of the general population in industrialized countries and preventive strategies.

Cadmium (Cd) is a heavy metal belonging to the group of the main chemical pollutants of the natural and occupational environment in economically developed countries. The forecasts indicate that contamination of the environment with this toxic metal, and thus the exposure of the general population, will increase. Food (particularly plant products) is the main source of the general population exposure to this element. Moreover, an important, and often the main, source of intoxication with Cd is habitual tobacco smoking. Recent epidemiological studies have provided numerous evidence that even low-level environmental exposure to this toxic metal, nowadays occurring in numerous economically developed countries, creates a risk for health of the general population. The low-level lifetime exposure to this metal may lead to the damage to the kidneys, liver, skeletal system, and cardiovascular system, as well as to the deterioration of the sight and hearing. Moreover, it has been suggested that environmental exposure to this xenobiotic may contribute to the development of cancer of the lung, breast, prostate, pancreas, urinary bladder, and nasopharynx. Taking the above into account, the aim of this review article is to draw more attention to Cd as an environmental risk factor for the health of the general population and the need to undertake preventive actions allowing to reduce the risk of health damage due to a lifetime exposure to this toxic metal.

Disparities of Selected Metal Levels in the Blood and Scalp Hair of Ischemia Heart Disease Patients and Healthy Subjects.

Imbalances in the concentrations of trace metals have become an increasingly recognized source of infirmity worldwide particularly in the development of ischemia heart disease (IHD). Present study is intended to analyze the concentrations of Ca, Cd, Co, Cr, Cu, Fe, K, Li, Mg, Mn, Na, Pb, Sr, and Zn in the blood and scalp hair of the patients and counterpart controls by flame atomic absorption spectrometry after wet-acid digestion. On the average, Cd, Co, Cr, Fe, K, Li, Mn, Na, and Pb revealed significantly elevated concentrations in the blood of the patients compared with the controls (p < 0.05), whereas mean levels of Ca, Cd, Fe, K, Li, Pb, and Sr in the scalp hair were significantly higher in the patients than the controls (p < 0.05). Most of the metals exhibited noticeable disparities in their concentrations based on gender, abode, dietary/smoking habits, and occupations of both donor groups. The correlation study and multivariate statistical analyses revealed some significantly divergent associations and apportionment of the metals in both donor groups. Overall, comparative variations of the metal contents in blood/scalp hair of the patients were significantly different than the controls; thus, evaluation of trace metals status may be indicative of pathological disorders, such as IHD.

Comparative statistical analysis of carcinogenic and non-carcinogenic effects of uranium in groundwater samples from different regions of Punjab, India.

LED flourimeter has been used for microanalysis of uranium concentration in groundwater samples collected from six districts of South West (SW), West (W) and North East (NE) Punjab, India. Average value of uranium content in water samples of SW Punjab is observed to be higher than WHO, USEPA recommended safe limit of 30µgl-1 as well as AERB proposed limit of 60µgl-1. Whereas, for W and NE region of Punjab, average level of uranium concentration was within AERB recommended limit of 60µgl-1. Average value observed in SW Punjab is around 3-4 times the value observed in W Punjab, whereas its value is more than 17 times the average value observed in NE region of Punjab. Statistical analysis of carcinogenic as well as non carcinogenic risks due to uranium have been evaluated for each studied district.