hematological disorders in relation to occupations

1. OCCUPATIONAL HAEMATOLOGICAL DISORDERS
Dr. Dalia Abdallah El-Shafei
Lecturer, Community medicine department, Zagazig University

2. #Haem synthesis
(Pb)
# cell production
(Benzene)
++ leukemia
(IR)
Haemolysis
(As + Naphthalen+
others)
# O2 delivery
(MetHb, SulfHb,
COHb)

3. ScreeningHistory
Physical
examination
Blood
examination
Bone marrow
examination
Other studies

4. HISTORY
 Usually, Non-specific symptoms.
• Anemia.
• Jaundice.
• Pica.
• Infections.
• Thrombocytopenia.
• Drug history.
 Detailed work history

5. PHYSICAL EXAMINATION
 Pallor, jaundice, cyanosis.
 Abnormal bleeding.
 Infections.
 Bone tenderness (sternum)

6. BLOOD EXAMINATION
 HB, Hematocrit value
 MCV, MCHC, MCH
 Peripheral blood smear ( RBCs morphology)
 Leucocytes differential count.
 Reticulocytes.

7. BONE MARROW EXAMINATION
 Iliac crest or sternum.
• Tumor cells
• Abnormal hematopoietic cells
• Chromosomal studies (proto-
oncogenes- philadelphia chromosome)

8. OTHER STUDIES
 Bleeding disorders (platelet count + PT +
PTT)
 Iron stores estimation (serum iron + TIBC +
serum ferritin)
 Hemolysis (LDH, Indirect bilirubin).
 Rapid cell turnover → ↑ serum Uric acid

9. INHIBITION OF HB SYNTHESIS
LEAD POISONING

10. "Lead makes the mind
give way."
ANCIENT AWARENESS
Greek
Dioscerides - 2nd BC

18. 150
10
20
30
40
50
100
Death
Encephalopathy
Nephropathy
Frank Anemia
Colic
Hemoglobin Synthesis
Vitamin D Metabolism
Encephalopathy
Frank Anemia
Decreased Longevity
Hemoglobin Synthesis
Nephropathy
Peripheral Neuropathies
Infertility (MEN)
Systolic Blood Pressure (MEN)
Hearing Acuity
Erythrocyte Protoporphyrin
(Women)
Hypertension (?)
Nerve Conduction Velocity
Erythrocyte Protoporphyrin
Vitamin D Metabolism(?)
DEVELOPMENTAL TOXICITY
IQ
HEARING
GROWTH
Transplacental Transfer
Blood Lead
(ug Pb/dl)
- Low birth weight
- Miscarriages, Stillbirth
- Premature birth
CHILDREN ADULTS

20. #HB synthesis
#Globin
synthesis
#Pyrimidine 5”-
nucleotidase
enz.
Iron
accumulation
Basic
Defects

21. ANEMIA AND LEAD TOXICITY (90%)
 Normochromichypochromic,
normocyticmicrocytic
 Reduced RBCs survival time
 Compensatory reticulocytes production
 reticulocytosis
 Basophilic stippling (70%)
 ↑ urinary excretion of ALA +
Coproporpherine III +Uroporphyrin +lead

22. MICROCYTIC ANEMIA
WITH BASOPHILIC STIPPLING

23. LEAD PROVOCATION TEST
 CaEDTA infusion “1g in 500ml 5%dextrose”
over 6 hs → 24-hs urinary lead.
• Normally < 0.5 mg
• Lead toxicity → ≥ 1 mg

26. INHIBITION OF CELL PRODUCTION
BENZENE POISONING

28. DESCRIPTION
 Colorless or light yellow liquid
 Sweet odor (Conc. Below threshold of
smell associated with toxicity)
 Highly flammable.
 Evaporates into the air very quickly. Its
vapor is heavier than air and may sink into
low-lying areas.

29. Glues, Paints,
Furniture wax,
Detergents
Tobacco smoke,
Gas stations, MV
exhaust, Industrial
emissions

31. HIGH-RISK BENZENE EXPOSURE JOBS
 Adhesive production
 Aircraft engine & fuel workers
 Automotive mechanics
 Brake technicians
 Chemical plant workers
 Engine & turbine workers
 Gasoline distribution workers
 House painters
 Newspaper press workers
 Painters
 Paper and pulp
 Pesticide
manufacturing
 Pipefitters
 Printers & print shop
 Refinery workers
 Shoe / leather workers
 Solvent workers
 Synthetic rubber
 Tankermen
 Truck drivers

33. MECHANISM OF TOXICITY
 Benzen induces pancytopenia by
disrupting cell production from the
pluripotent stem-cell stage to the
functional stage.
 There is good evidence that benzene is
cancerogenic.

34. GENETIC SUSCEPTIBILITY
Genetic variations of Myeloperoxidase
& NADPH quinine oxidoreductase

35.  Euphoria,
 Dizziness,
 Headache,
 Blurring of vision,
 Mucous membrane irritation,
 Tremor,
 Chest tightness,
 Respiratory depression,
 Cardiac arrhythmia,
 Coma
 Convulsion.
 Direct skin contact → Marked irritation due to
defeating action of the solvent.
ACUTE POISONING

36.  # BM cell proliferation:
 Anemia (including aplastic anemia),
leucopenia, thrombocytopenia, pancytopenia;
CHRONIC EXPOSURE

37.  Mutagenic effect:
 Leukemia (particularly of the myelomonocytic
type),
 Chromosomal abnormalities
 A dry, scaly dermatitis may developed on
prolonged or repeated skin exposure to liquid
benzene.

38. BM ASPIRATION

39.  Hypocellular with lymphocyte predominance
 + Immature cells
 No fibrosis
 Acute myelogenous leukemias (AML)
 Myeloma, CLL, CML

40. MANAGEMENT
 Blood transfusion
 Neutrophil transfusion
 Stem-cell transplantation from HLA identical
siblings:
 Sever aplastic anemia
 Young pt.
 Need immunosuppression

41. OTHER AGENTS # BM GROWTH
Aplastic anemia
Insecticides
“lindane”
Solvents
“glues, kerosesn,
”TNT, CCL4
IR

42. INDUCTION OF LEUKEMIA
IONIZING RADIATION

43. TYPES OR PRODUCTS OF IONIZING
RADIATION


or X-rayNeutron

44. COSMIC RADIATION

45. 2ry ionizing
effects
Indirect
ionization
Direct
ionization
• Neutrons
• x, rays
• α,
• Cosmic rays

46. Radiation interacting with cell molecules

47. IONIZING RADIATION AT THE CELLULAR
LEVEL
 Causes breaks in one or
both DNA strands or;
 Causes Free Radical
formation

48. OH
.
(hydroxyl radical)
H
.
Radiation Damage
water molecule
-ray
2 OH
.
 H2O2
What happens
when the water
molecule is
struck by the
gamma ray?

49. PENETRATION ABILITIES OF DIFFERENT
TYPES OF RADIATION
Alpha Particles
Stopped by a sheet of paper
Beta Particles
Stopped by a layer of clothing
or less than an inch of a substance
(e.g. plastic)
Gamma Rays
Stopped by inches to feet of concrete
or less than an inch of lead
Radiation
Source
Neutrons
Stopped by a few feet of concrete::
1:100:10,000

50. DOSE RESPONSE TISSUE
Very High White blood cells (bone marrow)
Intestinal epithelium
Reproductive cells
High Optic lens epithelium
Esophageal epithelium
Mucous membranes
Medium Brain – Glial cells
Lung, kidney, liver, thyroid, pancreatic
epithelium
Low Mature red blood cells
Muscle cells
Mature bone and cartilage

51. MYELODYSPLASTIC SYNDROME
Cytomenia +
remarkably cellular
BM
Dyserthropoiesis
Rigid sideroblasts
Variable no. of
blasts (<leukemia)
MDS
“pre-leukemic”

54. ACUTE RADIATION SYNDROME
(A SPECTRUM OF DISEASE)

56. ACUTE HEALTH EFFECTS
 Changes in the blood
cells
 Vascular changes
 Skin irritation
 Gastrointestinal effects
 Radiation sickness:
• Diarrhea
• Nausea
• Vomiting
• High fever
 Hair loss
 Burns

58. 58
MONITORING INSTRUMENTS
 Personal monitoring:
Film badges, bracelet, rings
Pocket dosimeter

59. Alpha Survey Meter
Detecting Radiation
Beta & Gamma
Survey Meter

60. LABORATORY FINDING
 CML, CLL.
 BM →↑ cellularity “ mainly Neutrophils”
 Chromosomal analysis:
Philadelphia chromosome
 Auer rods.

62. “King of Poisons, Poison of Kings”
HEMOLYTIC DISEASE
ARSINE POISONING

63. Industrial processes
 Semiconductor
manufacturing (gallium
arsenide)
 Fossil fuels
 Wood treated with arsenic
preservatives
 Metallurgy
 Smelting (copper, zinc,
lead) & refining of metals
& ores
 Glass manufacturing
 Commercial products
 Wood preservatives
 Pesticides
 Herbicides
 Fungicides
 Food
 Seafood and fish
 Others
 Antiparasitic drugs
 Folk remedies

65. OTHER HEMOLYTIC DISEASES

66. MARCH HEMOGLOBINURIA “FOOTSTRIKE
HEMOLYSIS” “RUNNER’S ANEMIA”
Repeated force (trauma) to the foot cause
the breakdown of RBCs in blood vessels.
CAUSES
Hard surfaces, long distances, Worn out
shoes, Inherited RBCs problem
(hereditary spherocytosis).

68. IMMUNE MEDIATED HEMOLYTIC ANEMIA

69. AGENTS INTERFERE WITH
O2 DELIVERY

70. METHEMOHLOBINEMIA

72. SULFHEMOGLOBINEMIA

73. CARBOB MONOXIDE