Abstract
Chronic workplace exposure to high nitrous oxide concentrations has been suggested to potentially be associated to negative health effects caused by the interference with the vitamin B12, methionine synthase pathway. The objective of the present study was to determine if delivery unit work place ambient air nitrous oxide exposure results in detectable hyperhomocysteinemia or signs of macrocytocis in personnel. Blood samples from thirty healthy female fulltime employees, midwives, aged 43 (range 25-62) years were studied. Routine blood test analysed for plasma homocysteine and blood status; haemoglobin, mean corpuscular volume, mean corpuscular haemoglobin concentration, blood status was analysed once before going on vacation and repeated after at least 10 days’ leave, nitrous oxide free period. Median time weighted average was 41 [10 - 547] ppm; 3 out of 11 TWA measurements were above recommended100 ppm limit. Median homocysteine concentrations were 10.7 [5.6 - 16] micromol/L with reference limits of 5.0 – 15 micromol/L. Megaloblastic erythrocytes was not detected in any personnel and no changes in blood status could be detected between before and after a nitrous oxide-free period. Conclusions: One of 3 delivery units’ ambient air quality measures exceed recommended ranges. No signs of routine blood test pathology could be seen in the personnel studied.
Highlights
Chronic working day exposure to nitrous oxide in healthcare workers is associated with alterations of vitamin B12 metabolic status, the extent of which depends on the level of exposure [1]
The plasma levels of homocysteine for these two nurses did not change after a vacation period of at least 14 days free from exposure to nitrous oxide
All mean corpuscular haemoglobin (MCH), mean corpuscular volume (MCV) or mean corpuscular haemoglobin concentration (MCHC) values were within reference ranges and there were no systematic changes in any variable when compared before versus after vacation Table 1
Summary
Chronic working day exposure to nitrous oxide in healthcare workers is associated with alterations of vitamin B12 metabolic status, the extent of which depends on the level of exposure [1]. Ventilation and scavenging is not always optimal in maternity wards and work place exposure has been shown to be not uncommonly exceeding set national recommendation, occupational exposure limits [3,4]. The inhibitory effects of nitrous oxide on the vitamin B12 dependent methionine synthase pathway have been suggested to be one of major factors for the developments of negative health effects [6]. Homocysteine and megaloblastic erythrocytes and anaemia are early signs from prolonged nitrous oxide exposure triggered methionine synthase inhibition [7,8]
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