Occupational Safety and Health Standards: Toxic and Hazardous Substances, Medical Screening and Surveillance for 1,3-Butadiene (Non-Mandatory)

If you are the victim of construction accidents, use this page to conduct research. To have your case evaluated immediately, please fill out our form. Read more about the Occupational Safety and Health Standards, 1910.1051 App C, Toxic and Hazardous Substances, Medical Screening and Surveillance for 1,3-Butadiene (Non-Mandatory).

I. Basis for Medical Screening and Surveillance Requirements

A. Route of Entry Inhalation

B. Toxicology

Inhalation of BD has been linked to an increased risk of cancer,

damage to the reproductive organs, and fetotoxicity. Butadiene can be

converted via oxidation to epoxybutene and diepoxybutane, two

genotoxic metabolites that may play a role in the expression of BD's

toxic effects.

BD has been tested for carcinogenicity in mice and rats. Both

species responded to BD exposure by developing cancer at multiple

primary organ sites. Early deaths in mice were caused by malignant

lymphomas, primarily lymphocytic type, originating in the thymus.

Mice exposed to BD have developed ovarian or testicular atrophy.

Sperm head morphology tests also revealed abnormal sperm in mice

exposed to BD; lethal mutations were found in a dominant lethal test.

In light of these results in animals, the possibility that BD may

adversely affect the reproductive systems of male and female workers

must be considered.

Additionally, anemia has been observed in animals exposed to

butadiene. In some cases, this anemia appeared to be a primary

response to exposure; in other cases, it may have been secondary to a

neoplastic response.

C. Epidemiology

Epidemiologic evidence demonstrates that BD exposure poses an

increased risk of leukemia. Mild alterations of hematologic

parameters have also been observed in synthetic rubber workers

exposed to BD.

II. Potential Adverse Health Effects

A. Acute

Skin contact with liquid BD causes characteristic burns or

frostbite. BD is gaseous form can irritate the eyes, nasal passages,

throat, and lungs. Blurred vision, coughing, and drowsiness may also

occur. Effects are mild at 2,000 ppm and pronounced at 8,000 ppm for

exposures occurring over the full workshift.

At very high concentrations in air, BD is an anesthetic, causing

narcosis, respiratory paralysis, unconsciousness, and death. Such

concentrations are unlikely, however, except in an extreme emergency

because BD poses an explosion hazard at these levels.

B. Chronic

The principal adverse health effects of concern are BD-induced

lymphoma, leukemia and potential reproductive toxicity. Anemia and

other changes in the peripheral blood cells may be indicators of

excessive exposure to BD.

C. Reproductive

Workers may be concerned about the possibility that their BD

exposure may be affecting their ability to procreate a healthy child.

For workers with high exposures to BD, especially those who have

experienced difficulties in conceiving, miscarriages, or stillbirths,

appropriate medical and laboratory evaluation of fertility may be

necessary to determine if BD is having any adverse effect on the

reproductive system or on the health of the fetus.

III. Medical Screening Components At-A-Glance

A. Health Questionnaire

The most important goal of the health questionnaire is to elicit

information from the worker regarding potential signs or symptoms

generally related to leukemia or other blood abnormalities.

Therefore, physicians or other licensed health care professionals

should be aware of the presenting symptoms and signs of

lymphohematopoietic disorders and cancers, as well as the procedures

necessary to confirm or exclude such diagnoses. Additionally, the

health questionnaire will assist with the identification of workers

at greatest risk of developing leukemia or adverse reproductive

effects from their exposures to BD.

Workers with a history of reproductive difficulties or a personal

or family history of immune deficiency syndromes, blood dyscrasias,

lymphoma, or leukemia, and those who are or have been exposed to

medicinal drugs or chemicals known to affect the hematopoietic or

lymphatic systems may be at higher risk from their exposure to BD.

After the initial administration, the health questionnaire must be

updated annually.

B. Complete Blood Count (CBC)

The medical screening and surveillance program requires an annual

CBC, with differential and platelet count, to be provided for each

employee with BD exposure. This test is to be performed on a blood

sample obtained by phlebotomy of the venous system or, if technically

feasible, from a fingerstick sample of capillary blood. The sample is

to be analyzed by an accredited laboratory.

Abnormalities in a CBC may be due to a number of different

etiologies. The concern for workers exposed to BD includes, but is

not limited to, timely identification of lymphohematopoietic cancers,

such as leukemia and non-Hodgkin's lymphoma. Abnormalities of

portions of the CBC are identified by comparing an individual's

results to those of an established range of normal values for males

and females. A substantial change in any individual employee's CBC

may also be viewed as "abnormal" for that individual even if all

measurements fall within the population-based range of normal values.

It is suggested that a flowsheet for laboratory values be included in

each employee's medical record so that comparisons and trends in

annual CBCs can be easily made.

A determination of the clinical significance of an abnormal CBC

shall be the responsibility of the examining physician, other

licensed health care professional, or medical specialist to whom the

employee is referred. Ideally, an abnormal CBC should be compared to

previous CBC measurements for the same employee, when available.

Clinical common sense may dictate that a CBC value that is very

slightly outside the normal range does not warrant medical concern. A

CBC abnormality may also be the result of a temporary physical

stressor, such as a transient viral illness, blood donation, or

menorrhagia, or laboratory error. In these cases, the CBC should be

repeated in a timely fashion, i.e., within 6 weeks, to verify that

return to the normal range has occurred. A clinically significant

abnormal CBC should result in removal of the employee from further

exposure to BD. Transfer of the employee to other work duties in a

BD-free environment would be the preferred recommendation.

C. Physical Examination

The medical screening and surveillance program requires an initial

physical examination for workers exposed to BD; this examination is

repeated once every three years. The initial physical examination

should assess each worker's baseline general health and rule out

clinical signs of medical conditions that may be caused by or

aggravated by occupational BD exposure. The physical examination

should be directed at identification of signs of lymphohematopoietic

disorders, including lymph node enlargement, splenomegaly, and

hepatomegaly.

Repeated physical examinations should update objective clinical

findings that could be indicative of interim development of a

lymphohematopoietic disorder, such as lymphoma, leukemia, or other

blood abnormality. Physical examinations may also be provided on an

as needed basis in order to follow up on a positive answer on the

health questionnaire, or in response to an abnormal CBC. Physical

examination of workers who will no longer be working in jobs with BD

exposure are intended to rule out lymphohematopoietic disorders.

The need for physical examinations for workers concerned about

adverse reproductive effects from their exposure to BD should be

identified by the physician or other licensed health care

professional and provided accordingly. For these workers, such

consultations and examinations may relate to developmental toxicity

and reproductive capacity.

Physical examination of workers acutely exposed to significant

levels of BD should be especially directed at the respiratory system,

eyes, sinuses, skin, nervous system, and any region associated with

particular complaints. If the worker has received a severe acute

exposure, hospitalization may be required to assure proper medical

management. Since this type of exposure may place workers at greater

risk of blood abnormalities, a CBC must be obtained within 48 hours

and repeated at one, two, and three months.

[61 FR 56746, Nov. 4, 1996]

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