INTRODUCTION
Cement
making is inevitably a dusty operation as it is much concerned with hot dry
powders and it is one of the largest manufacturing industries and its workers
are exposed to dust at various manufacturing and production process1
Most of the world’s population spent one
third of their life at work contributing actively to the development and
wellbeing of themselves, their family and the society. The right to health and
safety at work is therefore a part of basic human right2.
Environmental and occupational pollution has always been a major cause of
morbidity and mortality. The incidence of the occupational disease is
constantly increasing throughout the world, especially in developing country
due to lack of proper quality control documentation and partial approach towards
this mammoth problem.3 Studies carried out in Nigeria among cement
industry workers revealed an inventory of hazards such as respiratory problems,
irritation and contact dermatitis, organ-system perturbations particularly of
the lungs and liver, physical injuries
like burns, headache, fatigue and musculoskeletal disorders 4,5
Cement is one of the most essential building
materials in the world, and some of its constituents include calcium oxide,
silicon oxide, aluminum trioxide, ferric oxide magnesium oxide, sand and other
impurities6. The smoke and dust produced by some industries cause
various types of pathogenesis. The unhygienic exposure of the smoke and dust
are linked with an increased risk of chronic obstructive pulmonary diseases7.
In this vita, cement workers may also be exposed to numerous types of
occupational hazards, and these materials are the major culprits in mortality
and morbidity. The cement dust or its constituents causes pathogenesis of
various lung diseases including chronic bronchitis, asthma, lung cancer,
pneumonia and tuberculosis3
A study among cement workers in Nigeria
revealed that there were no specific training programs for safety education,
protective measures or accident prevention for workers. On the part of the
workers, study showed that the workers were reluctant to wear the proper
protective uniforms for their job. Various studies have also shown that workers
are unaware of the occupational hazards to which they are exposed8,9
METHODS
Study
Design and sampling
This
cross-sectional study was conducted among the brick layers and block makers in Owo Ondo State. Owo is situated in South-West Nigeria, at the Southern edge
of the Yoruba Hills, and at the intersection of roads from Akure,
Kabba, Benin City and Siluko
Blood
Samples Collection
About
10ml of blood samples were collected from the ante-cubital
fossa after disinfected with 70% alcohol from each subject. 4.5ml of the blood
were dispensed into citrate bottle containing 0.5ml of 3.2 tri-sodium citrate
solution in a ratio of blood to citrate, 9:1 (v/v). 5ml of the samples were dispensed into the
EDTA bottle. The blood was thoroughly mixed by inverting the container several
times gently. The citrate blood was spun
immediately in a bench centrifuge at 5000rpm to obtain platelet poor plasma
(PPP) for PT and PTTK while the EDTA sample was used for the platelet count.
The citrate samples were kept in the freezer for further analysis.
Prothrombin Time Assay
Principle:
The
presence of calcium, tissue thromboplastin initiates
the extrinsic coagulation pathway by the direct activation of factor VII to VIIa. This culminates in the conversion of soluble
fibrinogen to insoluble fibrin by the direct action of thrombin. Reduction in
the concentration of clotting factors of the extrinsic or common pathways will
result in the prolongation of the prothrombin time (PT),
the degree of which is proportional to the level of concentration reduction.
Procedure:
Into
a clean glass tube, 100ul of brain thromboplastin was
added, it was incubated for 2minutes at 370C, 100ul of plasma was
dispensed into it, 100ul of prewarmed calcium
chloride was also added and stop watch was started. The Tube was gently titled
at 2 seconds intervals (returning to the water bath between titling) and the
time for the formation of a clot was recorded in seconds. Control test was
equally run along with the plasma for each batch of test. The test was carried
out in duplicate for both subject’s sample and a normal control, and the mean
value was obtained.
Activated Partial thromboplastin
Time Assay
Principle
of the test:
Kaolin
(surface activator) and platelet substitute (phospholipid) activates the
coagulation factors of intrinsic pathway of blood coagulation mechanism in the
presence of calcium ion when incubated with citrated plasma at 370c and the
time taken for the mixture to clot is measured in seconds. APTT is prolonged by
a deficiency of one or more of these clotting factors of intrinsic pathway and
in the presence of coagulation inhibitors like heparin
Procedure
A clean glass tube was placed in a water bath
kept at 370C. 200ul of kaolin/platelet substitute was dispensed into
it and 100ul of plasma was added. After one minute, 100ul of pre-warmed 0.025M
calcium chloride (CaCl2) was dispensed and Stopwatch was started
immediately. The contents were gently mixed. The stopwatch was stopped
immediately at the sight of a fibrin clot and time was recorded. Control test
was equally run along with the test plasma for each batch of the test.
Platelet
count
Principle
Blood
is diluted 1 in 20 in a filtered solution of ammonium oxalate reagent which lysis the red cells. Platelets counted microscopically
using an improved Neubauer counting chamber and the
number of platelets per liter of blood calculated (Cheesbrough,
2010).
Procedure:
Into clean tube 20 µL of blood
was dispensed into 0.38ml of 1% ammonium oxalate and left for 15 minutes for
complete lysis of RBCs. Mounted the Neubauer chamber and left the chamber for 15 minutes in the
high humidity. Then counted the large central square.
RESULTS
We
set out to determine the effect of exposure to cement particles on platelet
count and some coagulation profiles among bricklayers and blocks molders in Owo township. The results of the
tests in table 1: showed a statistically significant increase in platelet count
(p<0.05) when compared to the control, while a statistically significant
reduced time of PT and APTT were recorded (p<0.05).
There is no statistically significant results
when the years of exposure were considered as shown in table 2 (p>0.05).
DISCUSSION
The
major pollution problem in cement factories is cement dust10. Exposure
to this dust may lead to damaging effects to biological systems, tissues and
organ. Harmful effects like dermatitis, laryngeal cancer, lung cancer,
Gastrointestinal tumor have been reported in cement dust exposed individuals11,12
The result obtained from this investigation
show a statistically significant increase in the level of platelet count in the
subject when compared with the control. This is in agreement with the previous
studies done by13,14 where it was reported an increase in platelet
level of workers in cement industry and attributed the increased to excess
production of hematopoietic regulatory element such as colony stimulating
factors, erythropoietin and thrombopoietin by the
stromal cells and macrophages in the bone marrow14. It has been
stated also that Inflammation causes release of factors like Tumor Necrosing Factor alpha that may stimulate increased
production of platelets from the bone marrow15. Platelet count can
also be potentially increased when a relatively large amount of body tissue is
damaged either by exposure to toxins, following surgery or after an accident.
Rose et al 16stated that infections are the most common cause of a
high platelet count in both adults and children. A raised Platelet count may
result in increased risk of cardiovascular disease in cement dust exposed
workers. Previous studies in different countries have shown changes in the
platelet count in cement factory workers14,17,18
The results of prothrombin
time test showed a significant decrease when compared with the control. Prothrombin time test (PT) is a screening test that detects
abnormalities in both the extrinsic and the common pathways of blood
coagulation. Prolong in the result of this test indicate a deficient of one or
more clotting factors that are present in this pathway or presence of
anticoagulant. Decrease in the result shows hyper activity in the pathway and
the result is similar to the work of Lee-Tsai19 where it was
reported that the shortness of the PT and APTT test are significant as associated
with a history of thrombotic event in Mexican population. The result of
Activated Partial Thromboplastin (APTT) from this
study when compared with the control was statistically significantly lower.
APTT is commonly used as part of a general screen for coagulation disorders in
patient with abnormal bleeding. The APTT evaluate the intrinsic pathway of
coagulation cascade. It is very sensitive to coagulation disorders and
deficiencies within the intrinsic pathway as well as heparin sodium therapy.
The result of this work correlate with the previous work done by20
where it was concluded that a shortened PT and APTT in dogs may be indicative
of hypercoagulability state as evidenced by an increased incidence of
thrombosis. Edson et al21 suggested that
short APTT may be correlated with elevated levels of the factor VIII procoagulant and possibly, a tendency for thrombosis. In
the work of Korte et al22
it was reported that the patients with a short APTT, are at significantly
increased risk for thromboembolism, mainly venous thromboses.
Previous studies have also revealed that shortened APTTs have been associated
with high levels of biochemical markers of thrombin generation and fibrin
deposition such as prothrombin fragment 1 + 2,
thrombin-antithrombin complex, and D-dimer22,23 as well as with a poor prognosis for thrombosis
and mortality24
Comparison of years
of exposure to cement dust particles and the measurement of all these
parameters were done, the differences seen in the results were not
statistically significant, indicating that year of exposure does not matter
once alteration either due to toxins or infection is done and remain in the
body.
CONCLUSION
The results of this work shows that exposure
to cement particles exposes the workers to hypercoagulability which is a
tendency to thrombosis and thromboembolism and can also leads to cardiovascular
disease.
Author’s Contribution
This
work was carried out in collaboration among all authors. All authors read and
approved the final manuscript.
Acknowledgment
We are grateful to the Staff of Hematology
and Blood Transfusion Science Department, Federal Medical Center, OWO. For
their immensely support towards this work. Also, we extend our gratitude to the
brick layers and block makers of Owo community for
giving us consent to take their Blood samples for this work.
Funding:
This research was self-sponsored
Conflict of interest: No conflict of interest
to declare.
Ethical
Clearance
Ethical
clearance for the study was granted by the Ethics Review of Federal Medical
Centre, OWO with no FMC/OW/380/VOL.CLV/150.
REFERENCES
1.
Merenu IA, Mojiminiyi
FBO, Njoku CH and Ibrahim MTO (2007): The effect of
Chronic Cement Dust Exposure on lung Function of cement Factory workers in Sokoto Nigeria. African journal of biomedical Research
10:139 – 143
2.
Merenu IA, Mojiminiyi
FBO, Njoku CH and Ibrahim MTO. The effect of Chronic
Cement Dust Exposure on lung Function of cement Factory workers in Sokoto Nigeria. African journal of biomedical Research
2007; 10:139 – 143
3.
Arshad HR, Ahmad A, Ali Y.B, Amjad AK and Mohammed AA. Effect of Exposure to cement dust
among the workers: An Evaluation of Health-Related Complications. Journal of
Medical Sciences 2018; 6(6):1159 – 1162
4.
Ezeonu FC, Ezeonu
JN and Edeogu OC. Occupational hazard in the Nigerian
cement industry Workers’ awareness and perception. African Newsletter on
occupational and safety; 2003;13:73 – 75
5.
Meo SA. Health hazards of cement dust. Saudi Medica Journal.2007; 25:1153 – 1159
6.
Oleru UG. Pulmonary function and symptoms
of Nigerian workers exposed to cement dust. Environmental Research, 1984;
33:379 – 385
7.
Viegi G, Scognamiglio
A, Baldacci S, Pistelli F, and Carrozzi
L. Epidemiology of chronic obstructive pulmonary disease (COPD). Respiration
2001; 68(1):4 - 19
8.
Awoyemi AO. An assessment of health
facilities and environmental conditions in some Nigerian stone quarries. Savanna
Medical Journal 2003; 4(1):19 – 21
9.
UgheokeA, Ebiomoyi
M, Iyawe V. Influence of smoking on respiratory
symptoms and Lung Functions indices in sawmill workers in Benin City, Nigeria. Niger
J Physiol Sci. 2006;21:49 - 54
10.
International
Labour Organization. Encyclopaedia
of occupational health and safety. 1999vol. 3,4th edition, pp
93.44-93.46 Geneva.
11.
Koh DH, Kim TW, Jang SH, Ryo HW. Cancer
Mortality and Incidence in Cement Industry Workers in Korea. Safe Health
Work. 2011; 2(3): 243-9.
12.
Nur N, Yilmaz A, Ersan S, Guler Sumer H, Bakir S. Effects of cement dust exposure on malonyldialdehyde levels and catalase activities in red
blood cells. Asian J Chem 2008;20(3):1815-1820
13.
Erhabor O. Kebbe B,
Isaac IZ, Yakubu AI, Marafa
Y, Okwesili AN, Buhari HA, Wase A, Onuigwe FU, Aghedo F, Ikhuenbor D, Mainasara A, Dallatu MK, UkoEK, Udomah FP, Iwueke IP, Adisa TC, Igbineweka OO. Effect of occupational exposure of cement
dust on some hematological parameters of workers in a cement company in Sokoto, Nigeria. International Journal of medical
Sciences and health 2013; 1(7):21 -35
14.
Emmanuel
TF, Ibiam UA, Okaka ANC, Alabi OJ. Effects of cement dust on the hematological
parameters in Obajana cement factory workers. Euro Sci J (ESJ).
2015; 11(27): 256-266
15.
Subha R, Koshy
RC. Reactive thrombocytosis and pseudo hyperkalemia-entities we come across
occasionally. Egypt J Anaesth. 2015; 31(1):
265-66.
16.
Rose
SR, Petersen NJ, Cardner TJ, Hamill RJ, Trainer BW.
Etiology of thrombocytosis in a general medicine population: analysis of 108
cases with emphasis on infection causes Journal of Clinical Medical Research
2012;4(6):415 -429
17.
Ashwini S, Swathi K, Saheb, SH. Effects of
cement dust on hematological and liver function tests parameters. Int J Current Pharmaceutical & Clinical
Researcher (IJCPCR). 2016; 6(2): 70-3.
18.
Neboh EE, Ufelle
SA, Achukwu PU, Ude, VC.
Cement dust exposure affects hematological parameters in cement loaders in
Enugu Metropolis, South-east Nigeria. J Exp Research.
2015; 3(1): 1-4.
19.
Lee-Tsai Y, Rosales-Badillo
L, Leyton-Rivera H, Majlut
Cruz A. Shortened Prothrombin Time and Activated Partial
Thromboplastin Time Test as a risk Factor for venous
or Arterial Thrombosis in Mexico (Abstract).https://abstracts.isth.org/abstract/shortened-prothrombin-time
and activated-partial-thromboplastin-time-tests-as-a-
risk-factor-for venous-or arterial-thrombosis-in –Mexico/Accessed December 5,
2023.
20.
Song
JDVM, Kenneth J, Drobatz DVM, Deborah C, Silverstein.
Retrospective evaluation of shortened prothrombin
time or activated partial thromboplastin for the
diagnosis of hyper coagulation in dogs: Journal of veterinary Emergency and
critical care 2016; 26(3):398 -405
21.
Edson
JK, Krivit, W While and JG Kaolin (1967): Partial thromboplastin time; high levels of procoagulants
producing short clotting time masking deficiencies of other procoagulant
or low concentrations of anticoagulant Journal of Laboratory Clinical Med 1967;
70463 – 70470.
22.
Korte W, Clarke S, Lefkowitz
JB. Short activated partial thromboplastin times are
related to increased thrombin generation and an increased risk for
thromboembolism. Am J Clin Pathol
2000; 113: 123-127.
23.
Ten
Boekel E, Bartels P. Abnormally short activated
partial thromboplastin times are related to elevated
plasma levels of TAT, F1+2, D-dimer and FVIII:C. Pathophysiology Haemost Thromb . 2002;32: 137-142.
24.
Reddy
NM, Hall SW, Mackintosh FR. Partial thromboplastin
time: prediction of adverse events and poor prognosis by low abnormal values.
Arch Intern Med. 1999;159: 2706-2710.
