title: An investigation of aircraft worker anemia: medical surveillance interpretation in an aging workforce.
abstract: OBJECTIVE
  To identify exposures possibly contributing to anemia cases among hexavalent chromium medical surveillance program enrollees.
  
  
  METHODS
  An investigation encompassed metals surveillance programs, extensive workplace sampling and remediation, consultation, evaluation of laboratory accuracy, and follow-up of anemic individuals.
  
  
  RESULTS
  Workers had underlying medical conditions that affected surveillance results. There was a systemic error in classification based on hematocrit value. The prevalence of anemia in a workforce averaging 52 years old was 16%.
  
  
  CONCLUSIONS
  Anemia may be more prevalent in middle-aged workers than expected. Modern laboratories generally report a calculated hematocrit value, and using hemoglobin for most classification purposes is preferred. Characteristics of a specific workforce, including age, health, hobbies, and diet, should be taken into account when interpreting medical surveillance program findings. The value of a team approach in addressing occupational health problems was demonstrated.
authors.affiliation: Navy and Marine Corps Public Health Center, Portsmouth, VA 23708, USA. john.muller@med.navy.mil
authors.forename: John
authors.initials: J
authors.lastname: Muller
authors.forename: Karen
authors.initials: K
authors.lastname: Allstadt
authors.forename: Christopher
authors.initials: C
authors.lastname: Rennix
authors.forename: Lawrence
authors.initials: L
authors.lastname: Betts
authors.forename: Patricia
authors.initials: P
authors.lastname: Krevonick
authors.forename: Mark
authors.initials: M
authors.lastname: Hammett
mesh_terms: D000401:Aircraft / Q000706:statistics & numerical data*; D000740:Anemia / Q000139:chemically induced* / Q000453:epidemiology; D001151:Arsenic / Q000097:blood / Q000633:toxicity / Q000652:urine; D001608:Beryllium / Q000097:blood / Q000633:toxicity / Q000652:urine; D003035:Cobalt / Q000097:blood / Q000633:toxicity / Q000652:urine; D005260:Female; D006801:Humans; D008297:Male; D019216:Metals, Heavy / Q000097:blood / Q000633:toxicity* / Q000652:urine; D008875:Middle Aged; D008982:Molybdenum / Q000097:blood / Q000633:toxicity / Q000652:urine; D009784:Occupational Diseases / Q000139:chemically induced* / Q000453:epidemiology; D016273:Occupational Exposure; D009790:Occupations; D011159:Population Surveillance; D014639:Vanadium / Q000097:blood / Q000633:toxicity / Q000652:urine
chemical_list: D019216:Metals, Heavy; D014639:Vanadium; D003035:Cobalt; D008982:Molybdenum; D001151:Arsenic; D001608:Beryllium