settings Order Article Reprints Open AccessFeature PaperArticle Lead, Mercury, and Cadmium Concentrations in Blood Products Transfused to Neonates: Elimination Not Just Mitigation by Sanaa M. Aly 1,2,* [ORCID] , Samar Elfiky 3, Yasmine G. Mohamed 3, Radwa A. M. Soliman 3, Nancy Shalaby 4, Nicolas Beauval 2,5, Jean-Michel Gaulier 2,5, Delphine Allorge 2,5 and Ahmed Omran 3 [ORCID] 1 Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt 2 CHU Lille, Service de Toxicologie-Génopathies, F-59000 Lille, France 3 Department of Pediatrics and Neonatology, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt 4 Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Damietta University, New Damietta 34517, Egypt 5 Université de Lille, ULR 4483—IMPECS—IMPact de l’Environnement Chimique sur la Santé Humaine, F-59000 Lille, France * Author to whom correspondence should be addressed. Toxics 2023, 11(8), 712; https://doi.org/10.3390/toxics11080712 Submission received: 23 June 2023 / Revised: 9 August 2023 / Accepted: 16 August 2023 / Published: 18 August 2023 (This article belongs to the Special Issue Overview of Forensic Toxicology, Yesterday, Today and in the Future) Download keyboard_arrow_down Browse Figure Versions Notes Abstract Lead (Pb), mercury (Hg), and cadmium (Cd) are identified as potent developmental neurotoxicants. Neonates are the main group receiving multiple blood transfusions. The exposure of neonates to these heavy metals (HMs) can occur through blood transfusions. This study aimed to determine the concentrations of lead (Pb), mercury (Hg), and cadmium (Cd) in various blood products (plasma, platelets, packed red blood cells (pRBCs), and whole blood (WB)) to explore the probability of concurrent exposure of these HMs and to identify the metal load per transfusion with risk assessment. Residual bloods from blood bank bags were collected after neonatal transfusion. Pb, Hg, and Cd concentrations were determined in 120 samples of blood products by inductively coupled plasma mass spectrometry (ICP-MS). Pb and Cd levels were over the normal levels in 19.2 and 5.9% of all blood units, respectively. In 35 and 0.8% of blood units, the Pb and Cd concentrations, respectively, were higher than that recommended for transfusions in premature neonates. The anticipated safe value was surpassed by 2.5% for Cd of all transfusions, primarily because of WB. However, Hg was detected only in 5.8% of all samples and their concentrations were within the normal range. The concurrent neonatal exposure to Pb, Hg, and Cd was statistically significant. Hazard quotients of Hg and Cr were >1 and Pb cancer risk was 2.41 × 10−4. To the best of our knowledge, this study is the first report examining Pb, Hg, and Cd in blood products other than WB and pRBCs using ICP-MS. This study demonstrated the exposure of neonates to Pb, Hg, and Cd during transfusion with a considerable amount of Pb. It confirms the significant concurrent exposure to the three HMs, which maximize their potential developmental neurotoxicity with a high probability of developing non-carcinogenic and carcinogenic health effects.