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Research Article
Some Biochemical and Hematological Parameters among
Petrol Station Attendants: A Comparative Study
Hala Samir Abou-ElWafa,1Ahmed A. Albadry,1
Abdel-Hady El-Gilany,1and Fagr B. Bazeed2
1Public Health & Community Medicine Department, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt
2Department of Medical Biochemistry, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt
Correspondence should be addressed to Hala Samir Abou-ElWafa; halsam@yahoo.com
Received August ; Revised October ; Accepted October
Academic Editor: Davor Zeljezic
Copyright © Hala Samir Abou-ElWafa et al. is is an open access article distributed under the Creative Commons
Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is
properly cited.
Objective. To describe selected biochemical and hematological parameters (blood picture, liver enzymes, and kidney functions) in
petrol station attendants in Mansoura city. Methods. is is a comparative cross-sectional study. e exposed group included
petrol station attendants. ey were compared to a matched group of healthy male service and oce workers at the Faculty of
Medicine, Mansoura University. e results of blood picture, liver enzymes, and kidney functions were compared between both
groups. Results. Mean Red Blood Cells (RBCs) count, hemoglobin level, and Hematocrit (HCT) level were signicantly lower in
petrol station attendants than the comparison group. All other blood picture parameters showed nonsignicant dierence between
both groups. Liver enzymes, renal functions, serum albumin, and total protein showed statistically nonsignicant dierence
between both groups except for alanine aminotransferase (ALT) which was signicantly higher in petrol station attendants.
Conclusions. Some laboratory parameters among petrol station attendants showed changes that could be attributed to workplace
exposure and should be given attention at preemployment and periodic medical examination.
1. Introduction
Petrol (or gasoline) is a mixture of volatile hydrocarbons,
while diesel fuel is a distillate of petroleum which contains
parans, alkenes, and aromatics [].
Fuel (petrol and diesel) lling station attendants (FFSAs)
are exposed to a mixture of hydrocarbons in fuel vapours
during dispensing fuel and to the gases from vehicular
exhaust []. In lling stations, the volume of fuel dispensed
as well as the ambient temperature contributes signicantly
to the increased emission of volatile hydrocarbons. Benzene
(BZ) could be considered to be the most hazardous; xylene
and toluene have toxicities in line with other aromatics of
lower/dierent concern compared to BZ [].
Certainpeoplehaveagreaterriskofexposuretogasoline
vapors; these include lling station workers, service station
attendants, drivers of gasoline trucks, and renery workers.
e volatile nature of petrol products makes them readily
availableintheatmosphereanytimeitisdispensed,especially
at petrol lling stations and depots [].
Many of the harmful eects seen aer exposure to
gasoline are due to the individual chemicals in the gasoline
mixture, such as benzene, lead, and oxygenates. Breathing
small amounts of gasoline vapors can lead to nose and
throat irritation, headaches, dizziness, nausea, vomiting,
confusion, and breathing diculties. Some eects of skin
contact with gasoline include rash, redness, and swelling.
Allergic reactions (hypersensitivity) have been reported but
these are rare occurrence [, ]. e adverse health eects of
gasoline exposure may be primarily related to impairment of
the haemopoietic system with bone marrow depression [].
Occupational diseases in gasoline lling workers have
been recognized for many years and aect workers in dier-
ent ways; such diseases are still problems in all parts of the
world. e numbers of such work-related diseases in devel-
opingcountriesaremuchhigherinrealitythanthenumbers
Hindawi Publishing Corporation
BioMed Research International
Volume 2015, Article ID 418724, 6 pages
http://dx.doi.org/10.1155/2015/418724
BioMed Research International
that are reported. e numbers of cases and types of occu-
pational diseases are increasing in both developing and
industrialized countries [].
To the best of the authors’ knowledge no past studies have
investigated the laboratory prole of petrol station attendants
as a result of their workplace occupational exposure in Egypt.
e objective of this study was to describe selected bio-
chemical and hematological parameters (blood picture, liver
enzymes, and kidney functions) in petrol station attendants
in Mansoura city.
2. Methods
A comparative cross-sectional study was conducted upon
petrol station attendants at Mansoura city during the period
from January , , to March , .
2.1. Subjects
2.1.1. e Study Group. ere are petrol stations in Man-
soura city and neighborhood as detected by “Google Earth.”
e study included out of petrol station attendants
with a response rate of %, recruited from stations with
the largest workforce (more than workers) and agreed to
participateinthestudy.Allattendantsaremalesworking
either in fuelling service for hours/day for three days in
one week and for four days in the next week in an alternating
pattern or in car maintenance and wash and oiling services
for hours/day from a.m. to p.m.
e petrol station attendants were interviewed and a
blood sample was taken at the administrative oce at each
stationata.m.wheretheirworkloadatthistimeisrelatively
light.
2.1.2. e Comparison Group. e group comprised male
service and oce workers at the Faculty of Medicine, Man-
soura University, comparable to petrol station attendants in
most of the variables except for the risk of exposure to petrol.
ey represent .% of all male service and oce workers.
ey were interviewed and examined at the department of
public health and community medicine during the work day.
Ethical Consideration.Approvalsofthestudiedpetrolsta-
tions, Faculty of Medicine authorities, and the research ethics
committee were obtained. An informed verbal consent of
study subjects to participate voluntarily in the study with a
full right to withdraw, as they were willing to make a health
check for free, was obtained with assurance of condentiality
andanonymityofthedata.
Each participant was subjected to the following:
() Interview: a questionnaire was used to collect the fol-
lowing information: sociodemographic and occupa-
tional prole of workers; usage of personal protective
equipment and reasons for nonusage; general health
status; and respiratory complaints.
() Laboratory investigation: a mL blood sample was
taken from each participant through venipuncture
which was then divided into the following:
(i)ereistwomLbloodcollectedinaplas-
tic tube containing ethylenediaminetetraacetic
acid (EDTA) for complete blood picture.
(ii) ere is three mL blood collected in a dry
plastic tube for kidney function tests (includ-
ing urea, uric acid, and creatinine) and liver
function tests (including ALT, aspartate amino-
transferase (AST), serum albumin, and total
protein).esamplewasallowedtoclotnat-
urally to separate the serum for analysis and
was stored upright at room temperature until it
was transported to the laboratory for analysis.
In the laboratory, each sample was centrifuged
and stored in the freezer at −∘Cuntilbeing
processed.
Data Analysis. Data were entered and statistically analyzed
using the Statistical Package for Social Sciences (SPSS)
version . e cut-o points for dierent parameters were
dened according to the laboratory standard dened by the
manufacturer of the kits. Qualitative data were described
as numbers and percentages. Chi-square (𝜒2)testwasused
for comparison between groups. Quantitative data were
described as means (standard deviation (SD)) or medians, as
appropriate. ey were tested for normality by Kolmogorov-
Smirnov test. In the normally distributed variables, indepen-
dent sample 𝑡-test was used, while in nonnormally distributed
variables, Mann Whitney test was used for comparison
between groups. “𝑝value ≤.” was considered to be
statistically signicant.
3. Results
Petrol station attendants matched the comparison group in all
sociodemographic and occupational prole items except for
the median duration of smoking which was longer in petrol
station attendants (Table ).
Mean RBCs count, hemoglobin level and the percent
anemic, and HCT level were signicantly lower in petrol
station attendants than the comparison group. All other
blood picture parameters showed nonsignicant dierence
between both groups (Table ).
Liver enzymes, renal functions, serum albumin, and total
protein(boththemeanlevelandthepercentageofabnormal
levels) showed statistically nonsignicant dierence between
both groups except for ALT which was signicantly higher in
petrol station attendants (Table ).
Both groups neither had health insurance, worn personal
protective equipment (PPE) due to their unavailability nor
had preemployment or periodic examination. Among petrol
station attendants, one (%) complained of headache and ver-
tigo, one (%) complained of morning cough and shortness
of breath, and two (%) complained of skin itch, redness, and
rash (data are not shown in tables).
4. Discussion
e association between exposure to benzene or benzene-
containing mixtures and certain types of blood disorders has
BioMed Research International
T : Sociodemographic and occupational proles of study groups.
Characteristic Petrol station attendants () Comparison group () Test of signicance
Age (years)
Mean ±SD . ±. . ±. 𝑡 = 0.12,𝑝 = 0.9
Number % Number %
Education
Illiterate/read and write . . 𝜒2= 2.1,𝑝 = 0.15
Primary and above . .
Marital status
Unmarried . . 𝜒2= 0.8,𝑝 = 0.4
Married . .
Residence
Rural . . 𝜒2= 0.4,𝑝 = 0.5
Urban . .
Typ e of contr a ct
Te mp o r ar y . . 𝜒2= 0.5,𝑝 = 0.5
Permanent . .
Duration of employment (ys)
Median (min–max) (.–) . (.–) 𝑍∗= 1.8,𝑝 = 0.08
Current smoking . . 𝜒2= 3.5,𝑝 = 0.06
Duration of smoking (ys)#
Median (min–max) (.–) (–) 𝑍∗= 2.4,𝑝 = 0.02
SD = standard deviation.
∗𝑍of Mann Whitney test.
#Among smokers.
T : Complete blood picture of the study groups.
Parameter Petrol station attendants () Comparison group () Test of signicance
Platelets (×9/L) . ±. . ±. 𝑡 = 1.2,𝑝 = 0.2
WBCs (×9/L) . ±. . ±. 𝑡 = 1.1,𝑝 = 0.3
RBCs (million cells/mcL) . ±. . ±. 𝑡 = 7.9,𝑝 ≤ 0.001
Hemoglobin (gm/dL) . ±. . ±. 𝑡 = 7.4,𝑝 ≤ 0.001
< gm/dL (.) (.) 𝑝 = 0.06
≥ gm/dL (.) (.)
HCT (%) . ±. . ±. 𝑡 = 8.2,𝑝 ≤ 0.001
MCV (femtoliter) . ±. . ±. 𝑡 = 0.4,𝑝 = 0.7
MCH (pg/cell) . ±. . ±. 𝑡 = 0.3,𝑝 = 0.8
MCHC (gm/dL) . ±. . ±. 𝑡 = 1.3,𝑝 = 0.2
Cells/mcL = cells per microliter, gm/dL = grams per deciliter, and pg/cell = picograms per cell.
been shown in epidemiological studies in dierent countries
[, ]. Benzene, an important component of petrol, is a
widely distributed environmental contaminant [] and has
mainly been associated with increased incidence of blood
disorders [].
e results of the study showed that the mean hemoglobin
level and RBCs count of petrol station attendants were
signicantly lower than those of the comparison group while
mean white blood cells (WBCs) and platelets counts were
higher among petrol station attendants with nonsignicant
dierence between both groups. Similarly, in hematological
assessment of gasoline exposure among petrol lling workers
in Baghdad, their mean hemoglobin level, WBCs, and RBCs
counts were signicantly lower than those of comparison
group [].
In this study, mean HCT value was signicantly lower in
petrolstationattendantsthancomparisongroupwhilemean
corpuscular volume (MCV), mean corpuscular hemoglobin
(MCH), and mean corpuscular hemoglobin concentration
(MCHC) were similar in both groups with statistically non-
signicant dierence between them. Previous studies did not
detect decreased blood cell counts on routine monitoring of
workers exposed to low level of benzene [, ].
Liqueed petroleum gas- (LPG-) exposed workers of
Gaza governorates were found to have signicantly higher
values of RBC, hemoglobin, HCT, MCH, MCHC, and
BioMed Research International
T : Liver enzymes, renal functions, serum albumin, and total protein of the study groups.
Laboratory parameter Petrol station attendants () Comparison group () Test of signicance
ALT (U/L) (–) (–) 𝑍 = 2.8,𝑝 = 0.004
Median (min–max)
> U/L (.) (.) —
≤ U/L (.) (.)
AST (U/L) (–) . (–) 𝑍 = 0.3,𝑝 = 0.8
Median (min–max)
> U/L (.) (.) 𝑝 = 0.9
≤ U/L (.) (.)
Uric acid (mg/dL) . (.–) . (.–) 𝑍 = 1.9,𝑝 = 0.06
Median (min–max)
>. mg/dL (.) (.) —
≤. mg/dL (.) (.)
Creatinine (mg/dL) . ±. . ±. 𝑡 = 1.8,𝑝 = 0.08
Mean ±SD
>. mg/dL (.) (.) 𝑝 = 0.6
≤. mg/dL (.) (.)
Urea (mg/dL) . ±. . ±. 𝑡 = 1.8,𝑝 = 0.07
Mean ±SD
> mg/dL (.) (.) 𝑝=1
≤ mg/dL (.) (.)
Serum albumin (gm/dL) . ±. . ±. 𝑡 = 1.8,𝑝 = 0.08
Mean ±SD
<. gm/dL (.) (.) —
≥. gm/dL (.) (.)
Total protein (gm/dL) . ±. . ±. 𝑡 = 1.9,𝑝 = 0.06
Mean ±SD
<. gm/dL (.) (.) 𝑝 = 0.2
≥. gm/dL (.) (.)
U/L = units per liter.
platelets than comparison group while the mean WBCs count
was signicantly lower. is study showed a signicant eect
of LPG exposure on the haematological parameters of LPG
workers compared to comparison group []. eir results
agree with the results of two studies of subjects exposed to
natural gas [, ].
In the study, the median values of ALT and AST were
higher among petrol station attendants than the comparison
group where ALT showed signicant dierence between
them while AST showed nonsignicant dierence. Similarly,
themeanvaluesofserumASTandALTweresignicantly
higher among LPG workers of Gaza governorates (. ±
. U/L and . ±. U/L, resp.) compared with controls
(. ±. U/L and . ±. U/L, resp.) []. ese results
also agree with the results obtained from other settings for
LPG or natural gas exposures. Hu et al. [] showed that
long term exposure to coke oven emissions increased the
risk of liver dysfunction, while Chen et al. [] and Wu
et al. [] explored the dose-response relationship between
exposure to natural gas emissions in coke oven workers and
the elevation of some serum liver enzymes and reported a
signicant elevation of some liver enzymes in these workers
that may have been related to their exposure to natural gas.
Abnormal liver functions alongside neurological symptoms
were reported in a case report of a male, following accidental
inhalation of natural gas containing propane and butane [].
is study showed that serum uric acid, urea, and cre-
atinine levels were higher among petrol station attendants
than comparison group however statistically nonsignicant.
Similarly, serum levels of urea and creatinine were shown
to be signicantly elevated in gasoline lling workers in
Sulaimani City, Kurdistan, more than comparison group,
though these values are still within the highest accepted
normal ranges []. Also, the study of LPG workers of Gaza
governorates showed that urea, creatinine, and uric acid
levels were signicantly higher in workers compared with
controls []. However, Viau et al. [] did not nd signicant
eects on kidney function markers of renery workers who
were occupationally exposed to hydrocarbons, the major
component of natural or LPG gas.
is study showed lower mean values of serum albu-
minandtotalproteinamongpetrolstationattendantsthan
comparison group with statistically nonsignicant dierence
between them. In Sulaimani City, Kurdistan, total plasma
BioMed Research International
protein levels were not signicantly changed in gasoline
lling station workers compared to nonexposed subjects,
while plasma albumin levels were signicantly elevated in
workersmorethancomparisongroup[].
Fuel products are mixtures of aliphatic and aromatic
hydrocarbons mostly related to gasoline; most of them are
toxic to many organ systems including the kidney [,
], which may be attributed to an increase in liberating
toxic metabolites including reactive oxygen species. While
experiments with rats indicate that exposure by inhalation
to the aromatic hydrocarbons toluene, styrene, and xylene
was nephrotoxic [], this eect has not been conrmed in
man []. Both human and experimental studies suggest that
many chemicals can aect the kidney []. Gasoline includes
many chemicals and additives where anyone could be the
cause for such deterioration in renal functions. Accordingly,
the identication of specic solvents and exposed job cate-
gories at risk would improve intervention to prevent or delay
mild renal impairment progression to end-stage renal disease
in the occupational setting [].
In this study, % of petrol station attendants complained
of headache and vertigo, morning cough, and shortness of
breath, and % complained of skin itch, redness, and rash.
e results of the study of workers at lling and distribution
stations of LPG of Gaza governorates showed signicantly
higher rates of nearly all health status items in LPG workers
than comparison group, especially experiencing headache or
fatigue in work, eye itches, redness, pain, skin itches, redness
and rash, and respiratory complaints, such as fatigue during
climbing stairs, repeated sneezing during working hours,
shortness of breath in poorly ventilated room, and shortness
of breath in the workplace [].
Studies in dierent settings showed similar results to
that of Gaza Strip, especially concerning health complaints
related to respiratory system [, ]. ese health-related
complaintsofLPGworkersarelikelytobeduetothepharma-
cological eect of LPG. Inhalation of gaseous propane, which
is the major component of LPG, is known to cause dizziness,
nausea, vomiting, confusion, hallucinations, and a feeling of
euphoria [] and to suppress central nervous system (CNS)
function [].
e frequency of general health and respiratory com-
plaints among petrol station attendants in our study is low
despitethenonuseofPPEatworkandthiscouldbeattributed
to the outdoor location of petrol stations together with the
enclosed system for fuelling vehicles that could minimize
exposure to benzene.
Study Limitations
is study suers some limitations. ere were no records
for baseline and periodic medical examination of workers to
identify changes that could be attributed to petrol exposure.
Being a small-scale study limits the generalization of results
to the total population of petrol station attendants. Also there
was no environmental and personal monitoring for petrol
exposure to be related to the laboratory changes. e health
hazards could be underestimated as petrol attendants who
experienced serious hazards may had been exempted from
work or changed it.
Recommendations
ere should be the introduction of initial medical or
laboratory testing for petrol station attendants before being
hired to their jobs to check their tness and suitability for
duties at petrol stations. A medical observation including
preemployment and periodic medical checkup for early
recognition and removal of sensitive workers from their
working places before development of chronic impairment
should be done. e availability and use of PPE at work to
minimize workplace petrol exposure should be encouraged.
Further longer term perspective studies of petrol workers
help to get a more comprehensive picture of long term eects
of petrol exposure.
Conflict of Interests
e authors declare that there is no conict of interests
regarding the publication of this paper.
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