The role of occupational and environmental exposures in the aetiology of acquired severe aplastic anaemia: a case control investigation

• Published in: British journal of haematology Vol. 123; no. 5; pp. 906 - 914
• Main Authors: Muir, K. R., Chilvers, C. E. D., Harriss, C., Coulson, L., Grainge, M., Darbyshire, P., Geary, C., Hows, J., Marsh, J., Rutherford, T., Taylor, M., Gordon‐Smith, E. C.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Ltd 01-12-2003; Blackwell; Blackwell Publishing Ltd
• Subjects: Adolescent; Adult; aetiology; Aged; Agriculture; Anemia, Aplastic - chemically induced; Anemia, Aplastic - etiology; Anemias. Hemoglobinopathies; aplastic anaemia; Biological and medical sciences; Case-Control Studies; Child; Child, Preschool; Commerce; Diseases of red blood cells; environment; Environmental Exposure; epidemiology; Female; Hematologic and hematopoietic diseases; Hematology; Hobbies; Household Products - adverse effects; Humans; Industry; Infant; Logistic Models; Male; Medical sciences; Medical Staff; Middle Aged; Multivariate Analysis; occupation; Occupational Diseases - chemically induced; Occupational Diseases - etiology; Occupational Exposure; Pesticides - adverse effects; Radiation; Risk; Social Class; Solvents - adverse effects; Human; occupation; Aplastic anemia; Pesticides; Hemopathy; Occupational exposure; Epidemiology; aplastic anaemia; environment. epidemiology; Health and environment; Etiology; Irradiation; aetiology; Solvent
• ISSN: 0007-1048; 1365-2141
• DOI: 10.1046/j.1365-2141.2003.04718.x

Aplastic anaemia is a rare but serious disorder with a high morbidity and mortality rate. The causes of aplastic anaemia are, for the most part, unknown. We report on the hypothesis that aplastic anaemia may be caused by occupational and/or environmental exposures to certain chemicals. The UK Aplastic Anaemia Study was an interview‐based case–control study covering the whole of Great Britain. Those patients diagnosed between 1 July 1993 and 20 October 1997, aged ≤75 years and born and diagnosed in the UK were eligible for the study. Two hundred eligible cases of aplastic anaemia were compared with 387 age‐ and sex‐matched controls. A number of occupational exposures showed increases in risk. In a multivariate model of these exposures the odds ratios (ORs) for solvents/degreasing agents, pesticides and radiation were >2 and statistically significant. Reported chemical treatment of houses within 5 years of diagnosis had a significantly raised risk for adults [OR = 2·51, 95% confidence interval (CI) 1·02–12·01], particularly for woodworm treatment (OR = 5·1, 95% CI 1·5–17·4). This study identified significant risks associated with self‐reported exposure to solvents, radiation and pesticides in the workplace. Self‐reported chemical treatment of houses was also associated with an increased risk of developing aplastic anaemia, in keeping with previous literature.