Effect of Plasma and Blood Donations on Levels of Perfluoroalkyl and Polyfluoroalkyl Substances in Firefighters in Australia: A Randomized Clinical Trial

Faculty of Medicine, Health and Human Sciences, Macquarie University, New South Wales, Australia. Department of Haematology, Concord Repatriation General Hospital, New South Wales, Australia. Centre for Emotional Health and School of Psychological Sciences, Macquarie University, New South Wales, Australia. Now with Research, Innovation & Enterprise, Office of the Deputy Vice Chancellor, Research, Macquarie University, New South Wales, Australia. High Consequence Chemical Response Capability Project, Fire Rescue Victoria (FRV), Victoria, Australia. FRV Advocacy, FRV, Victoria, Australia. Laboratory Haematology Department, St Vincent's Hospital, Melbourne, Victoria, Australia. Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada. Retired, Cambridge, United Kingdom. Christian Regenhard Center for Emergency Response Studies, City University of New York, New York. Incident Response Unit, Environmental Services and Regulation, Queensland Department of Environment and Science, Queensland, Australia. Environment Protection Authority Victoria, EPA Science, Centre for Applied Sciences, Macleod, Melbourne, Victoria, Australia. Earth and Environmental Sciences, Faculty of Science & Engineering, Macquarie University, New South Wales, Australia.

JAMA network open. 2022;5(4):e226257

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Abstract
IMPORTANCE Elevated levels of blood perfluoroalkyl and polyfluoroalkyl substances (PFASs) have been associated with a range of adverse health outcomes. Firefighters have been exposed to PFASs in firefighting foams and have previously been shown to have higher PFAS levels in blood samples than the general population. No interventions have been shown to reduce PFAS levels. OBJECTIVE To examine the effect of blood or plasma donations on PFAS levels in firefighters in Australia. DESIGN, SETTING, AND PARTICIPANTS This 52-week, open-label, randomized clinical trial enrolled participants from May 23 to August 23, 2019. Participants were 285 Fire Rescue Victoria staff or contractors with serum levels of perfluorooctane sulfonate (PFOS) of 5 ng/mL or more who were eligible to donate blood, had not donated blood in the 3 months prior to randomization, and were able to provide written informed consent. Analysis was performed on an intention-to-treat basis from May to July 2021. INTERVENTIONS Firefighters with baseline PFOS levels of 5 ng/mL or more were randomly assigned to donate plasma every 6 weeks for 12 months, donate blood every 12 weeks for 12 months, or be observed only. MAIN OUTCOMES AND MEASURES The primary end points were changes in the serum PFOS and perfluorohexane sulfonic acid (PFHxS) levels after 12 months of plasma or blood donations or after observation only. Secondary end points included changes in serum PFAS levels from week 52 to week 64, changes in other PFASs, and changes in complete blood count, biochemistry, thyroid function, and lipid profile from screening to week 52. RESULTS A total of 285 firefighters (279 men [97.9%]; mean [SD] age, 53.0 [8.4] years) were enrolled; 95 were randomly assigned to donate plasma, 95 were randomly assigned to donate blood, and 95 were randomly assigned to be observed. The mean level of PFOS at 12 months was significantly reduced by plasma donation (-2.9 ng/mL; 95% CI, -3.6 to -2.3 ng/mL; P < .001) and blood donation (-1.1 ng/mL; 95% CI, -1.5 to -0.7 ng/mL; P < .001) but was unchanged in the observation group. The mean level of PFHxS was significantly reduced by plasma donation (-1.1 ng/mL; 95% CI, -1.6 to -0.7 ng/mL; P < .001), but no significant change was observed in the blood donation or observation groups. Analysis between groups indicated that plasma donation had a larger treatment effect than blood donation, but both were significantly more efficacious than observation in reducing PFAS levels. CONCLUSIONS AND RELEVANCE Plasma and blood donations caused greater reductions in serum PFAS levels than observation alone over a 12-month period. Further research is needed to evaluate the clinical implications of these findings. TRIAL REGISTRATION anzctr.org.au Identifier: ACTRN12619000204145.
Study details
Language : eng
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine