title: Grand rounds: outbreak of hematologic abnormalities in a community of people exposed to leakage of fire extinguisher gas.
abstract: BACKGROUND
  Although there are ample data on the respiratory effects of exposure to fire extinguisher gas, the potential hematologic effects have not been fully documented. We conducted this study to determine the possible etiologic agent(s) for a decrease in red blood cells among community residents in Taipei, Taiwan, after they were exposed to leakage of mixed fire extinguishants containing bromotrifluoromethane (CF3Br, Halon 1301), bromochlorodifluoromethane (CF2BrCl, Halon 1211), and dichlorodifluoromethane (CCl2F2, CFC-12).
  
  
  METHODS
  We studied 117 exposed residents who came into one hospital for physical examinations. We also selected age- and sex-matched referents for comparison from residents who came to the same hospital for health examinations. Nine months after the exposure to mixed fire extinguishants, 91 of the exposed residents came back for a second physical examination. In the first examination of the exposed residents, we found a significant reduction in red blood cell count and hemoglobin and a relationship between dose and response.
  
  
  CONCLUSIONS
  After excluding iron-deficiency anemia, thalassemia, and other possible agents, we suspected that the hematologic effects might have resulted from pyrolytic products of CFC-12 and Halon 1211, which may contain phosgene, among other products.
  
  
  CONCLUSIONS
  The acute transient hematologic effects observed in the exposed residents were associated with the incident of leakage of mixed fire-extinguisher gases and were most likely caused by a small amount of pyrolytic products, probably phosgene. Nine months after the exposure, we found a significant improvement in the abnormalities without any specific treatment.
authors.affiliation: Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, Taiwan.
authors.forename: Shih-Hsiang
authors.initials: SH
authors.lastname: Lo
authors.forename: Chang-Chuan
authors.initials: CC
authors.lastname: Chan
authors.forename: Wei-Chin
authors.initials: WC
authors.lastname: Chen
authors.forename: Jung-Der
authors.initials: JD
authors.lastname: Wang
mesh_terms: D000328:Adult; D064228:Bromochlorofluorocarbons; D005617:Chlorofluorocarbons, Methane / Q000633:toxicity*; D004781:Environmental Exposure / Q000009:adverse effects; D004906:Erythrocyte Count; D004912:Erythrocytes / Q000187:drug effects*; D005260:Female; D005388:Fire Extinguishing Systems; D005411:Flame Retardants / Q000633:toxicity; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D013624:Taiwan / Q000453:epidemiology
chemical_list: D064228:Bromochlorofluorocarbons; D005617:Chlorofluorocarbons, Methane; D005411:Flame Retardants; D006454:Hemoglobins; C034013:bromotrifluoromethane; C037990:bromochlorodifluoromethane; C007782:dichlorodifluoromethane