Review Article

The Efficacy of Periodic Complete Blood Count Tests in Evaluation of the Health Status of Radiation Workers in Iran: A Systematic Review


Background: Periodic medical examinations of radiation workers are routinely conducted in many countries. Although low dose radiation (LDR) is not expected to cause a significant effect on blood count, the periodic examination usually includes reviewing the work history, general medical history, a physical examination and collecting a blood sample. Despite lymphocytes are the most sensitive cells to radiation, their counts do not show any significant change as long as the radiation level is less than a few hundreds of millisievert (mSv). In spite of this, in Iran, radiation workers, even those who work in diagnostic radiology departments, are regularly examined for blood count changes.

Methods: After a detailed search in PubMed, ISI, Scopus, SID and Google Scholar, only 12 out of 650 articles matched our criteria. A review of these 12 reports was conducted. The full texts were fully reviewed by the authors.

Results: The complete blood count (CBC) test has a very low efficacy in evaluation of the adverse health effects of ionizing radiation in radiation workers. Therefore, finding alternative methods with a higher efficacy is recommended.

Conclusion: CBC tests cannot be introduced as valid markers of potential radiation effects in most occupational exposures. Given this consideration, in periodic tests of radiation workers, cytogenetic tests can be the gold-standard method. In particular, due to its relatively low cost and good sensitivity and specificity, the dicentric assay can be promising. Moreover, the simple and rapid evaluation of micronuclei by fast automated scoring systems can be a good alternative for current low efficacy CBC tests.

1. Zakova M (2001). Occupational exposure in angiography (Prague workplaces). Radiat Prot Dosimetry, 94(1-2): 129-132.
2. Puthran S, Sudha K, Rao GM, et al (2009). Oxidative stress and low dose ionizing radiation. Indian J Physiol Pharmacol, 53(2): 181-184.
3. Klucinski P, Mazur B, Sedek L, et al (2014). Assessment of selected B cells populations in the workers of X-ray departments. Int J Occup Med Environ Health, 27(3): 467-473.
4. Cengiz M, Grkaynak M, Vural H, et al (2003). Tissue trace element change after total body irradiation. Nephron Exp Nephrol, 94(1): e12-16.
5. Kopjar N, Garaj-Vrhovac V (2005). Assessment of DNA damage in nuclear medicine personnel--comparative study with the alkaline comet assay and the chromosome aberration test. Int J Hyg Environ Health, 208(3): 179-191.
6. Cardoso RS, Takahashi-Hyodo S, Peiti P Jr, et al (2001). Evaluation of chromosomal aberrations, micronuclei, and sister chromatid exchanges in hospital workers chronically exposed to ionizing radiation. Teratog Carcinog Mutagen, 21(6): 431-439.
7. Evans HJ, Buckton KE, Hamilton GE, Carothers A (1979). Radiation-induced chromosome aberrations in nuclear-dockyard workers. Nature, 277(5697): 531-534.
8. Ward E, Hornung R, Morris J, et al (1996). Risk of low red or white blood cell count related to estimated benzene exposure in a rubberworker cohort (1940-1975). Am J Ind Med, 29(3): 247-257.
9. Tavakoli M, Moradalizadeh M, Ananisarab GR, Hosseini SM (2012). Evaluation of blood cell count in the radiology staff of Birjand Hospitals in 2011. Modern Care Scientific Journal, 9(2): 80-86
10. Davudiantalab A, Farzanegan Z, Mahmoudi F (2018). Effects of Occupational Exposure on Blood Cells of Radiographers Working in Diagnostic Radiology Department of Khuzestan Province. Iran J Med Phys, 15(2): 67.
11. Karimi G, Balali-Mood M, Alamdaran SA, et al (2017). Increase in the Th1-Cell-Based Immune Response in Healthy Workers Exposed to Low-Dose Radiation - Immune System Status of Radiology Staff. J Pharmacopuncture, 20(2): 107–111.
12. Abdolmaleki A, Sanginabadi F, Rajabi A, Saberi R (2012). The effect of electromagnetic waves exposure on blood parameters. Int J Hematol Oncol Stem Cell Res, 6(2):13-16.
13. Salek Moghaddam AR, Sharafi AA, Osati Ashtiani F, Jalali Galousang F (2004). Comparative evaluation of cellular and humoral immunity parameters in radiographers and non radiographers. Razi J Med Sci, 10(37): 727-733.
14. Zargan S, Seyedmehdi SM, Emami H, Attarchi MS, Yazdanparast T (2016). Comparison of blood cells in radiology workers and non-radiation workers staff of a governmental hospital in Tehran. Iran Occup Health, 13(4): 31-38.
15. Elahimanesh F, Allaveisi F, Zahedi R, et al (2018). Evaluation of changes in blood factors, liver functional tests, and thyroid tests in radiation workers in hospitals in kurdistan province. J Isfahan Med Sch, 35(453): 1532-1539.
16. Heydarheydari S, Shookoh S, Almasi A, Sohrabi N (2012). Evaluation of the Effects of Ionizing Radiation on Radiation Worker’s Blood Parameters of Kermanshah hospitals. Journal of Clinical Research in Paramedical Sciences, 1(3):e82194.
17. Heydarheydari S, Haghparast A, Eivazi MT (2016). A Novel Biological Dosimetry Method for Monitoring Occupational Radiation Exposure in Diagnostic and Therapeutic Wards: From Radiation Dosimetry to Biological Effects. J Biomed Phys Eng, 6(1): 21–26.
18. Riahi-Zanjani B, Balali-Mood M, Alamdaran SA (2014). Evaluation of the serum total antioxidant level and hematological indices in healthy workers exposed to low radiation doses: A significant increase in platelet indices. Pharmacologyonline, 1: 63-67.
19. Heidari S, Taheri M, Ravan AP, et al (2016). Assessment of some immunological and hematological factors among radiation workers. J Biol Today's World, 5(7): 113-9.
20. Davoudi M, Keikhaei B, Tahmasebi M, Rahim F (2012). Hematological profile change in radiation field workers. Apadana Journal of Clinical Research, 1: 38-44.
21. Khedr M (2017). Evaluation the Effect of Low Dose Ionizing Radiation on Radiological Staff. IOSR Journal of Applied Physics, 9(2): 1-7.
22. Sayed D, Abd Elwanis ME, Abd Elhameed SY, Galal H (2011). Does occupational exposure to low-dose ionizing radiation affect bone marrow thrombopoiesis?. Int Arch Med, 4:8.
23. Tuschl H, Kovac R, Wottawa A (1990). T-lymphocyte subsets in occupationally exposed persons. Int J Radiat Biol, 58(4): 651-659.
24. Izak M, Bussel JB (2014). Management of thrombocytopenia. F1000Prime Rep, 6:45.
25. Kelsey KT, Memisoglu A, Frenkel D, Liber HL (1991). Human lymphocytes exposed to low doses of X-rays are less suscepti-ble to radiation-induced mutagenesis. Mu-tat Res, 263(4): 197-201.
26. Wilkins RC, Romm H, Oestreicher U et al (2011). Biological Dosimetry by the Tri-age Dicentric Chromosome Assay - Fur-ther validation of International Network-ing. Radiat Meas, 46(9):923–928.
27. Pan Y, Ruan J, Gao G, Wu L et al (2019). Laboratory Intercomparison of Cytoge-netic Dosimetry Among 38 Laboratories in China. Dose Response, 17(1):1559325819833473.
28. Lusiyanti Y, Syaifudin M, Budiantari T et al (2019). Development of Dose-Response Calibration Curve for Dicentric Chromo-some Induced by X-Rays. Genome Integr, 10:2.
29. Jang S, Lee JK, Cho M et al (2016). Consec-utive results of blood cell count and ret-rospective biodosimetry: useful tools of health protection regulation for radiation workers. Occup Environ Med, 73(10):694–700.
30. Kasuba V, Rozgaj R, Jazbec A (2008). Chromosome aberrations in peripheral blood lymphocytes of Croatian hospital staff occupationally exposed to low levels of ionising radiation. Arh Hig Rada Toksikol, 59(4): 251-259.
31. Abtahi S, Aghamiri S, Yadolahi M, Mahmoudzadeh A (2017). Dependence of micronuclei assay on the depth of absorbed dose. Rep Pract Oncol Radiother, 22(6): 470–476.
32. Zakeri F, Rajabpour MR, Haeri SR, et al (2011). Chromosome aberrations in peripheral blood lymphocytes of individuals living in high background radiation areas of Ramsar, Iran. Radiat Environ Biophys, 50(4): 571-578.
33. Vinnikov VA (2017). Optimizing the Microscopy Time Schedule for Chromosomal Dosimetry of High-dose and Partial-body Irradiations. Genome Integr, 8:3.
IssueVol 49 No 4 (2020) QRcode
SectionReview Article(s)
Radiation workers; Complete blood count (CBC); Safety; Risk

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How to Cite
ZARE A, MORTAZAVI SMJ. The Efficacy of Periodic Complete Blood Count Tests in Evaluation of the Health Status of Radiation Workers in Iran: A Systematic Review. Iran J Public Health. 2020;49(4):628-636.