Transcript Lead Health Effects

Lead Health Effects
Warren Silverman MD
Occupational exposure
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Construction workers
Steel welders
Bridge reconstruction workers
Firing range instructors and cleaners
Painters
Remodelers and refinishers
Foundry workers
Scrap metal recyclers
Auto repairers
Cable splicers
Hobbies
– Casting bullets or fishing sinkers
– Home remodeling
– Target shooting at firing ranges
– Lead soldering
– Auto repair
– Stained glass making
– Glazed pottery making
Substance Use
– Some folk remedies
– Some "Health Foods"
– Moonshine whiskey
– Ceramicware
Take Home Lead
• Lead particles or dust can be brought into the
home and family vehicle on work clothes and
equipment.
• Since blood borne lead crosses the placenta, a
pregnant woman with an elevated blood lead level
may expose her fetus to the toxic effects of lead.
• Lead poisoning in children is especially dangerous
because it can cause learning problems and serious
illness. If young children live in the home and a
parent works with lead, they should be tested.
Lead serves no biological function in the human
body
• The OSHA Lead in Construction Standard requires
– medical surveillance employees who are occupationally exposed to
lead at or
– above the action level of 30 μg/m3.
• initial medical surveillance, includes biological monitoring for
blood lead levels and zinc protoporphyrin (ZPP).
• Employees exposed to lead at or about the action level for more
than 30 days in a consecutive 12-month period shall be enrolled in
a medical surveillance program that includes at least the
• following:
– detailed work history,
– medical history, and
– thorough physical exam, with attention to the neurological system,
kidneys, teeth, gums, blood, blood pressure, heart, gastrointestinal
system, and lungs.
Frequency of Medical Examination
• Medical examination for lead exposure
is to be conducted: annually, if the
blood lead level (BLL) has been greater
than 40 μg/dL in the past 12 months;
• If signs and symptoms of lead exposure
appear, and
• as otherwise deemed medically
appropriate
Medical Examination
• A detailed work history and a medical history, with
particular attention to past lead exposure
(occupational and non-occupational), personal
habits (smoking, hygiene), and past
gastrointestinal, hematologic, renal, cardiovascular,
reproductive and neurological problems;
• 1926.62(j)(3)(ii)(B) A thorough physical
examination, with particular attention to teeth,
gums, hematologic, gastrointestinal, renal,
cardiovascular, and neurological systems.
Pulmonary status should be evaluated if respiratory
protection will be used;
• 1926.62(j)(3)(ii)(C) A blood pressure measurement;
Medical Testing
• 1926.62(j)(3)(ii)(D) A blood sample and analysis which
determines:
• 1926.62(j)(3)(ii)(D)(1) Blood lead level;
• 1926.62(j)(3)(ii)(D)(2) Hemoglobin and hematocrit
determinations, red cell indices, and examination of
peripheral smear morphology;
• 1926.62(j)(3)(ii)(D)(3) Zinc protoporphyrin;
• 1926.62(j)(3)(ii)(D)(4) Blood urea nitrogen; and,
• 1926.62(j)(3)(ii)(D)(5) Serum creatinine;
• 1926.62(j)(3)(ii)(E) A routine urinalysis with microscopic
examination;
• 1926.62(j)(3)(ii)(F) Any laboratory or other test relevant
to lead exposure which the examining physician deems
necessary by sound medical practice.
Removal
Construction 1926.62
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General industry 1910.1025
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The employer shall remove
any employee from work
when BLL results are greater
than 50 mg/dL.
An employee on medical
removal may return to work
with a BLL at or below 40
mg/dL or upon approval of
the physician.
Employees on medical
removal shall be provided
with up to 18 months of
medical removal protection
benefits on each occasional
of removal due to BLL.
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The employer shall remove an employee
from work having an exposure to lead at or
above the action level on each occasion that
a periodic and a follow-up blood sampling
test conducted pursuant to this section
indicate that the employee's blood lead level
is at or above 60 ug/100 g of whole blood
The employer shall remove an employee
from work having an exposure to lead at or
above the action level on each occasion that
the average of the last three blood sampling
tests conducted pursuant to this section (or
the average of all blood sampling tests
conducted over the previous six (6) months,
whichever is longer) indicates that the
employee's blood lead level is at or above 50
ug/100 g of whole blood; provided, however,
that an employee need not be removed if
the last blood sampling test indicates a blood
lead level at or below 40 ug/100 g of whole
blood.
Medical Opinion
• Upon the finding or suspicion of exposure to lead,
the employer shall provide the employee with a
written medical opinion from the examining
physician that includes at least:
– detected medical condition(s) placing employee at
increased risk,
– recommended PPE,
– respiratory protection limitations, and blood lead
levels.
• The physician’s medical opinion should not contain
diagnoses unrelated to occupational exposure.
Neurological Effects
– Peripheral neuropathy
– Fatigue / Irritability
– Impaired concentration
– Hearing loss
– Wrist / Foot drop
– Seizures
– Encephalopathy
Gastrointestinal Effects
– Nausea
– Dyspepsia
– Constipation
– Colic
– Lead line on gingival tissue
• Reproductive Effects
– Miscarriages/Stillbirths
– Reduced sperm count & motility
– Abnormal sperm
• Heme Synthesis
– Anemia
– Erythrocyte protoporphyrin elevation
• Renal Effects
– Chronic nephropathy with proximal tubular
damage
– Hypertension
• Other
– Arthralgia
– Myalgia
• >80 µg/dL,
– serious, permanent health damage may occur
(extremely dangerous).
• Between 40 and 80 µg/dL,
– serious health damage may be occurring, even if there
are no symptoms (seriously elevated).
• Between 25 and 40 µg/dL,
– regular exposure is occurring. There is some evidence
of potential physiologic problems (elevated).
• Between 10 and 25 µg/dL,
– lead is building up in the body and some exposure is
occurring
Medical removal in
OSHA standard is 50
First, test each worker before they begin any work involving lead
Then test that worker every month:
For the first 3 months of testing, and
Whenever the previous blood lead level was greater than 25
µg/dL (If the previous blood lead level was at least 50 µg/dL, a
follow-up test within 2 weeks and medical removal is required),
or
Whenever an increase of at least 10 µg/dL from the previous test
is observed
After the first three months, continue testing every 2 months:
When the blood lead levels have remained below 25 µg/dL for 3
months, and
If an increase less than 10 µg/dL from the previous test is
observed
Test every 6 months:
When the blood lead levels remain below 25 µg/dL for 6 months,
and
If an increase less than 10 µg/dL from the previous test is
observed
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