Difficulties in conducting preliminary and periodic medical examinations of workers in contact with ionizing radiation sources

A well-studied effect of irradiation is a lesion of the hematopoietic system, manifested by cytopenic changes in peripheral blood of varying severity. A decrease in the concentration of blood cells in those working under these conditions has always been a reason for conducting an in-depth examination in order to exclude radiation genesis and identify the true cause of these changes. However, in the current Order of the Ministry of Health of the Russian Federation dated 28.01.2021 No. 29n, among the contraindications for working under irradiation, there are no leukocytopenia and thrombocytopenia, as well as other conditions, the development of which is possible due to exposure to the radiation factor.

The study aims to assess the prevalence of cytopenia in employees of one of the enterprises subordinate to the FMBA of Russia exposed to radiation at the workplace, and the sufficiency of the requirements of clause 4.1 (ionizing radiation, radioactive substances) of Order No. 29n regarding the preservation of health and the detection of diseases/conditions that prevent the continuation of work in these conditions.

Scientists have conducted the analysis of the results of periodic medical examinations of 54 employees who have been in contact with ionizing radiation sources in the workplace for 6 years. We used methods of variational statistics for the analysis.

Among 54 workers exposed to radiation at the maximum permissible doses, 21.5% had mild to moderate cytopenia (leuko-, lympho-, granulocytopenia and anemia). Scientists have repeatedly identified these conditions in 12.1%, these conditions. In 1.4%, granulocytopenia and thrombocytopenia were combined with proteinuria detected once in 2020. We have observed throughout all 6 years of follow-up proteinuria without combination with cytopenia in 3 workers. During 6 years of observation the authors have repeatedly observed cytopenia in 13% of workers. 

The analysis revealed objective difficulties that have arisen recently in connection with the entry into force of the order of the Ministry of Health of the Russian Federation No. 29n. The absence of such contraindications to work as leukocytopenia and thrombocytopenia in paragraph 4.1, regulating the conduct of medical examinations in workers under irradiation, allows people with signs of possible damage to the hematopoietic system to continue working without the necessary examination and search for the cause of cytopenia. It is necessary to restore in clause 4.1 of the current order such contraindications to work as leukopenia <4.0×10⁹/l, thrombocytopenia <180.00×10⁹/l.

Limitations. The study is limited by a contingent of employees of a nuclear industry enterprise who received a dose of external radiation and contamination with radionuclides within acceptable limits. Experts study the sufficiency of the requirements of the current Order of the Ministry of Health of the Russian Federation No. 29n to identify signs of damage to the ionizing radiation of the hematopoietic system.

Ethics. The authors have conducted the study in compliance with the requirements of the Ethics Committee of the A.I. Burnazyan Federal State Budgetary Research Center of the FMBA of Russia, Protocol No. 68 of March 18, 2022.

Contribution:
Galstyan I.A., Bushmanov A.Yu. — concept and design of the study;
Galstyan I.A., Parinov O.V., Metlyaev E.G., Konchalovsky M.V. — data collection and processing;
Galstyan I.A., Lyaginskaya A.M., Kretov A.S., Vlasova I.V. — writing the text;
Torubarov F.S., Metlyaeva N.A., Yunanova L.A. — editing.

Funding. The study was conducted under Contract No. 11/13917D dated 01.10.2020.

Conflict of interests. The authors declare no conflict of interests.

Received: 07.04.2022 / Accepted: 17.05.2022 / Published: 25.06.2022

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