title: 2,4,6-Trinitrotoluene (TNT) air concentrations, hemoglobin changes, and anemia cases in respirator protected TNT munitions demilitarization workers.
abstract: OBJECTIVE
  2,4,6-Trinitrotoluene (TNT) is an explosive used in munitions production that is known to cause both aplastic and hemolytic anemia in exposed workers. Anemia in a TNT worker is considered a sentinel health event (occupational) (SHE(O)) in the United States (US). Deaths have been reported secondary to aplastic anemia. Studies have shown that TNT systemic absorption is significant by both the respiratory and dermal routes. No studies encountered looked at hemoglobin change or anemia cases in respiratory protected workers. It is hypothesized that respiratory protection is insufficient to protect TNT workers from the risk of anemia development and hemoglobin concentration drop.
  
  
  METHODS
  A records review of eight groups of respiratory protected TNT workers' pre-exposure hemoglobin levels were compared with their during-exposure hemoglobin levels for statistically significant (alpha level 0.05) hemoglobin level changes, and anemia cases were recorded. A curve estimation analysis was performed between mean TNT air concentrations and mean hemoglobin change values.
  
  
  RESULTS
  Statistically significant hemoglobin level drops and anemia cases were apparent at TNT air concentrations about the REL and PEL in respiratory protected workers. There were no anemia cases or statistically significant hemoglobin level drops at concentrations about the TLV, however. A statistically significant inverse non-linear regression model was found to be the best fit for regressing hemoglobin change on TNT air concentration.
  
  
  CONCLUSIONS
  Respiratory protection may be inadequate to prevent workers who are at risk for TNT skin absorption from developing anemia. This study contributes evidence that the TLV should be considered for adoption as the new PEL.
authors.affiliation: Veterans Administration VISN 8 Patient Safety Center of Inquiry, James A. Haley Veterans Administration Medical Center, Tampa, FL, USA. Melville.bradley2@va.gov
authors.forename: Melville D
authors.initials: MD
authors.lastname: Bradley
mesh_terms: D000388:Air / Q000032:analysis; D000741:Anemia, Aplastic / Q000175:diagnosis / Q000209:etiology* / Q000378:metabolism; D004305:Dose-Response Relationship, Drug; D004784:Environmental Monitoring; D053834:Explosive Agents / Q000009:adverse effects* / Q000032:analysis / Q000378:metabolism; D005260:Female; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D019570:Inhalation Exposure; D008297:Male; D009784:Occupational Diseases / Q000209:etiology*; D016273:Occupational Exposure; D012134:Respiratory Protective Devices; D012189:Retrospective Studies; D014303:Trinitrotoluene / Q000009:adverse effects* / Q000032:analysis / Q000378:metabolism; D054041:Weapons; D017132:Workplace
chemical_list: D053834:Explosive Agents; D006454:Hemoglobins; D014303:Trinitrotoluene