Dear mail base:

I will be grateful for information whether any lab is doing frequent routine monitoring for staff regularly exposed to chemotherapeutic agents (e.g. nurses, pharmacist, and any others exposed regularly to chemotherapy). Below is a copy and paste from OSHA standards.

I will be interested to know your practice regarding this point.

Many thanks

Mohamed

Dr Mohamed Elsammak

Consultant Chemical Pathologist

King Fahd Specialist Hospital Dammam

E. Occupational Exposure: Biological Evidence of Absorption

1. Urinary Mutagenicity

a. Falck et al. were the first to note evidence of mutagenicity in the urine of nurses who handled cytotoxic drugs.²⁶ The extent of this effect increased over the course of the work week. With improved handling practices, a decrease in mutagenic activity was seen.²⁷ Researchers have also studied pharmacy personnel who reconstitute antineoplastic drugs. These employees showed increasingly mutagenic urine over the period of exposure; when they stopped handling the drugs, activity fell within 2 days to the level of unexposed controls.⁵^,⁷⁶ They also found mutagenicity in workers using horizontal laminar flow BSC's that decreased to control levels with the use of vertical flow containment BSC's.⁷⁶

b. Other studies have failed to find a relationship between exposure and urine mutagenicity.²⁵ Sorsa⁹⁹ summarizes this information and discusses the factors, such as differences in urine collection timing and variations in the use of PPE, which could lead to disparate results. Differences may also be related to smoking status; smokers exposed to CD's exhibit greater urine mutagenicity than exposed nonsmokers or control smokers -- suggesting contamination of the work area by CD's and some contribution of smoking to their mutagenic profile.⁹

2. Urinary Thioethers are glutathione conjugated metabolites of alkylating agents, which have been evaluated as an indirect means of measuring exposure. Workers who handle cytotoxic drugs have been reported to have increased levels compared to controls and also have increasing thioether levels over a 5-day work week.⁴⁴^,⁴⁸ Other studies of nurses who handle CD's and of treated patients have yielded variable results, which could be due to confounding by smoking, PPE, and glutathione-S-transferase activity.¹¹

3. Urinary Metabolites. Venitt assayed the urine of pharmacy and nursing personnel handling cisplatin and found platinum concentrations at or below the limit of detection for both workers and controls.¹¹² Hirst found cyclophosphamide in the urine of two nurses who handled the drug, documenting worker absorption.³⁵ (Hirst also documented skin absorption in human volunteers by using gas chromatography after topical application of the drug.) Urinary pentamidine recovery has also been reported in exposed health care workers