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An Investigation of Aircraft Worker Anemia: Medical Surveillance Interpretation in an Aging Workforce

Muller, John MD, MPH; Allstadt, Karen MD, MPH; Rennix, Christopher ScD, MS; Betts, Lawrence MD, PhD; Krevonick, Patricia BS; Hammett, Mark MD, MPH

Journal of Occupational and Environmental Medicine: May 2011 - Volume 53 - Issue 5 - p 548–552
doi: 10.1097/JOM.0b013e318216d471
Original Articles

Objective: To identify exposures possibly contributing to anemia cases among hexavalent chromium medical surveillance program enrollees.

Methods: An investigation encompassed metals surveillance programs, extensive workplace sampling and remediation, consultation, evaluation of laboratory accuracy, and follow-up of anemic individuals.

Results: Workers had underlying medical conditions that affected surveillance results. There was a systemic error in classification based on hematocrit value. The prevalence of anemia in a workforce averaging 52 years old was 16%.

Conclusions: Anemia may be more prevalent in middle-aged workers than expected. Modern laboratories generally report a calculated hematocrit value, and using hemoglobin for most classification purposes is preferred. Characteristics of a specific workforce, including age, health, hobbies, and diet, should be taken into account when interpreting medical surveillance program findings. The value of a team approach in addressing occupational health problems was demonstrated.

From the Navy and Marine Corps Public Health Center (Drs Muller, Rennix, and Hammett and Ms Krevonick), Portsmouth, Va; Occupational Medicine Clinic (Dr Allstadt), Naval Hospital Jacksonville, Jacksonville, Fla; Eastern Virginia Medical School, Norfolk and US Navy. Poquoson, Va (Dr Betts).

Address correspondence to: John Muller, MD, MPH, FACOEM, Navy and Marine Corps Public Health Center, 620 John Paul Jones Cir, Ste 1100, Portsmouth, VA 23708 (

J.M., K.A., C.R., and P.K. are employed by the US Navy. M.H. is a US Navy service member. L.B. was a paid consultant to the US Navy during this investigation. The views expressed in this article are solely those of the authors and do not reflect the official policy or position of the US Navy, the Department of Defense, or the US Government.

©2011The American College of Occupational and Environmental Medicine