ENVIRONMENTAL HEALTH
A Non-Conventional Matrix:
Potential Use of Dried Blood Spots for Biomonitoring
by Jennifer Liebreich, MPH, senior specialist, Environmental Health
Limited information exists about the
extent of human exposure to many
environmental chemicals, and the
potential toxic health effects of these
chemicals in humans are largely
unknown. Dried blood spots (DBS)
could provide biomonitoring data for
populations from whom collecting blood
is difficult such as children. Children are
recognized as being more susceptible
to the effects of potentially harmful
environmental chemicals. This article
provides an overview of the potential
use of DBS for biomonitoring based on a
chapter on the topic.
Addressing Sample Collection and
Sample Sensitivity Concerns
In population-based studies,
biomonitoring data can be useful to
establish background levels of select
environmental chemicals and can help
identify population groups most highly
exposed. The US Centers for Disease
Control and Prevention’s (CDC’s) National
Health and Nutrition Examination Survey
(NHANES) is considered the gold standard
of biomonitoring population-based
surveillance in the US. However, even in
NHANES, biomonitoring data for infants
and young children are limited because
of age restrictions around collection of
blood, making DBS look like an attractive
alternative. However, NHANES is not a
proponent of including DBS because of
technical issues related to difficulty in
standardizing collection of capillary blood.
Biomonitoring generally requires
measuring chemicals at trace
concentrations (parts per billion or lower)
so biomonitoring with DBS must use
analytical methods providing adequate
sensitivity and selectivity at such
concentrations, which is challenging and
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A scientist sorts through DBS punches. Photo: Iowa Department of Public Health
Biomonitoring directly measures the actual concentration of environmental
chemicals or their metabolites in human biospecimens, and, when used
in combination with indirect measures of exposure like questionnaires,
biomonitoring data can provide useful information about differences in
exposure across geography, race/ethnicity, and socioeconomic status.
Blood and urine are most commonly used for biomonitoring.
costly. Additional challenges relate to
standardization of collection of capillary
blood vs venipuncture, and presence
of other endogenous and exogenous
chemical substances on the DBS.
Further analytical considerations for
biomonitoring using DBS include limited
sample volume; contributions from
the filter paper; extraction of biological
material from the filter paper; stability;
and comparison of data between DBS and
serum, plasma or whole blood. DBS offer
the promise of making biomonitoring
available to a wide range of populations
but also represent substantial analytical
challenges for both method development
and quantitation of analytes (chemicals).
While there are concerns with using
DBS for biomonitoring of endogenous
chemical substances, it has been recently
noted that DBS can serve as a good matrix
for chemicals such as nerve agents
and opioids.
Calafat, A. M. and Kato, K. In Dried Blood Spots: Applications and Techniques, Li, W.; Lee, M. S. Eds.; John Wiley & Sons: Hoboken, NJ, 2014; Chapter 10.
Seymour C 1 , Shaner RL 2 , Feyereisen MC 2 , Wharton RE 2 , Kaplan P 3 , Hamelin EI 2 , Johnson RC 2 . Determination of Fentanyl Analog Exposure Using Dried Blood Spots with LC-MS-MS. J Anal Toxicol. 2018 Nov 20.
Shaner RL 1 , Coleman RM 1 , Schulze N 2 , Platanitis K 2 , Brown AA 2 , Seymour C 3 , Kaplan P 2 , Perez J 1 , Hamelin EI 4 , Johnson RC 1 . Investigation of dried blood sampling with liquid chromatography tandem mass
spectrometry to confirm human exposure to nerve agents. Anal Chim Acta. 2018 Nov 29;1033:100-107.
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