Evaluating the liver in hazardous waste workers.
Hodgson-MJ; Goodman-Klein-BM; Thiel-DH
Occup Med: State of the Art Rev 1990 Jan; 5(1):67-78
Screening and surveillance of liver disease in hazardous waste workers was discussed. The epidemiological aspects of liver disease were summarized. Liver injury tests (LITs) have been widely used to diagnose liver disease; however, interpreting the results of such tests in hazardous waste workers potentially exposed to hepatotoxins is difficult because the predictive value of LITs for liver disease is not generally known, the long term prognosis of transient or minor increases in LIT parameters is not clear, and interpreting biological monitoring data is difficult. Risk factors to consider when conducting medical examinations for liver disease included a history of exposure to hepatotoxins, obesity, alcohol use, gender, and diabetes. Laboratory tests used for nonspecific monitoring of liver disease. These included LITs, liver function tests, and urinary excretion of porphyrins and other metabolites. No hepatotoxic dose response relationship for most of the agents found in hazardous waste sites has been established. A protocol used to detect liver disease in hazardous waste site workers consisted of obtaining an initial history and medical examination. The examination included LITs such as alanine-aminotransferase and aspartate-aminotransferase determinations. Persons with LIT elevations less than 1.5 times the normal values were cleared for hazardous waste work; however, the LITs are repeated at least twice over the next 2 weeks. Persons who have persistently elevated LITs that are twice the normal values were removed from exposure at sites having known or suspected hepatotoxins. For persons who develop abnormal LITs while working at hazardous waste sites, exposure monitoring and site sample data were reviewed to determine if the LITs could reflect occupational exposure. The authors recommend that a worker registry be established to allow long term followup of workers with abnormal LITs.
NIOSH-Publication; NIOSH-Grant; Occupational-health; Surveillance-programs; Waste-disposal; Liver-function; Biochemical-indicators; Risk-analysis; Epidemiology; Hazardous-waste-cleanup; Risk-factors; Liver-disorders
Medicine University of Pittsburgh 149 Lothrop Hall Pittsburgh, PA 15261
Occupational Medicine: State of the Art Reviews. Hazardous Waste Workers
University of Pittsburgh at Pittsburgh, Pittsburgh, Pennsylvania