Note: | • Employees who wear respirators need to be medically evaluated to make sure the respirator will not harm them, before they are assigned work in areas requiring respirators. Employees who decline to receive medical examination and testing to monitor for health effects caused by benzene are not excluded from receiving a separate medical evaluation for a respirator use. |
• If employers discourage participation in medical monitoring for health effects caused by benzene, or in any way interfere with an employee's decision to continue with this program, this interference may represent unlawful discrimination under RCW 49.17.160, Discrimination against employee filing, instituting proceeding, or testifying prohibited—Procedure—Remedy. |
Note: | If the written opinion contains specific findings or diagnoses unrelated to occupational exposure, send it back and obtain a revised version without the additional information. |
When conducting | Include | |
An initial evaluation | • | A detailed history including: |
– | Past work exposure to benzene or other hematological toxins; | |
– | Exposure to marrow toxins outside of current employment; | |
– | Exposure to ionizing radiation; | |
– | Family history of blood dyscrasias including hematological neoplasms; | |
– | History of blood dyscrasias including genetic hemoglobin abnormalities, bleeding abnormalities, and abnormal function of formed blood elements; | |
– | History of renal or liver dysfunction; | |
– | History of medications routinely taken. | |
• | A complete physical examination: | |
– | Include a pulmonary function test and specific evaluation of the cardiopulmonary system if the employee is required to use a respirator for at least thirty days a year. | |
• | A complete blood count including a: | |
– | Leukocyte count with differential; | |
– | Quantitative thrombocyte count; | |
– | Hematocrit; | |
– | Hemoglobin; | |
– | Erythrocyte count and indices (MCV, MCH, MCHC). | |
• | Additional tests the examining LHCP determines are necessary based on alterations in the components of the blood or other signs that may be related to benzene exposure. | |
• | Medical follow-up as required in Table 5. | |
Annual evaluations | • | An updated medical history covering: |
– | Any new exposure to potential marrow toxins; | |
– | Changes in medication use; | |
– | Any physical signs associated with blood disorders. | |
• | A complete blood count including a: | |
– | Leukocyte count with differential; | |
– | Quantitative thrombocyte count; | |
– | Hematocrit; | |
– | Hemoglobin; | |
– | Erythrocyte count and indices (MCV, MCH, MCHC). | |
• | Additional tests that the examining LHCP determines necessary, based on alterations in the components of the blood or other signs that may be related to benzene exposure. | |
• | A pulmonary function test and specific evaluation of the cardiopulmonary system every three years if the employee is required to use a respirator for at least thirty days a year. | |
• | Medical follow-up as required in Table 5. | |
Evaluations triggered by employee signs and symptoms commonly associated with the toxic effects of benzene exposure | • | An additional medical examination that addresses elements the examining LHCP considers appropriate. |
Evaluations triggered by employee exposure during an emergency | • | A urinary phenol test performed on the exposed employee's urine sample within seventy-two hours of sample collection. |
– | The urine sample must be collected at the end of the work shift associated with the emergency; | |
– | The urine specific gravity must be corrected to 1.024. | |
• | Medical follow-up as required in Table 5. | |
Reference: | ||
Employees who are not covered by medical evaluation requirements in this chapter may be covered by medical evaluation requirements in other chapters such as Emergency response, chapter 296-824 WAC. |
If | Then | ||
• | The complete blood count test result is normal. | • | No further evaluation is required. |
• | The complete blood count test shows any of the following abnormal conditions: | • | Repeat the complete blood count within two weeks: |
– | A leukocyte count less than 4,000 per mm³ or an abnormal differential count; | – | If the abnormal condition persists, refer the employee to a hematologist or an internist for follow-up medical examination and evaluation, unless the LHCP has good reason to believe it is unnecessary; |
OR | – | The hematologist or internist will determine what follow-up tests are necessary; and | |
– | A thrombocyte (platelet) count that is either: | ||
■ | More than 20% below the employee's most recent values; | • | Follow the requirements found in Medical removal, WAC 296-849-12050. |
OR | |||
■ | Outside the normal limit (95% C.I.) according to the laboratory; | ||
OR | |||
– | The hematocrit or hemoglobin level is either of the following, and can not be explained by other medical reasons: | ||
■ | Below the normal limit (outside the 95% C.I.), as determined by the laboratory for the particular geographical area; | ||
OR | |||
■ | Persistently decreasing compared to the employee's preexposure levels. | ||
Results from the urinary phenol test conducted during an emergency evaluation show phenol levels less than 75 mg/L. | • | No further evaluation is required. | |
Results from the urinary phenol test conducted during an emergency evaluation show phenol levels equal or more than 75 mg/L. | • | Provide a complete blood count monthly for three months. Include a: | |
– | Leukocyte count with differential; | ||
– | Thrombocyte count; | ||
– | Erythrocyte count; and | ||
• | If any of the abnormal conditions previously listed in this table for complete blood count results are found: | ||
– | Provide the employee with periodic examinations, if directed by the LHCP; and | ||
– | Refer the employee to a hematologist or an internist for follow-up medical examination and evaluation unless the LHCP has good reason to believe a referral is unnecessary; and | ||
– | Follow the requirements found in Medical removal, WAC 296-849-12050; and | ||
– | The hematologist or internist will determine what follow-up tests are necessary. |