A person who prepares or administers antineoplastic agents may be exposed to these agents, resulting in acute or chronic toxicity. A program should be in place to monitor these patients for risk and signs of toxicity. Documentation of training, exposures, assessments and other pertinent information should be preserved in permanent long-term storage.

Risk assessment may include:

(1) toxicity of compounds exposed to

(2) extent of exposure to compounds

(3) accidents, spills and acute exposures

(4) adherence to approved technique for safe handling

(5) use of personal protective equipment (PPE) and engineering controls

(6) risk factors predisposing to toxicity

(7) additional exposures that may increase risk (such as radiation or smoking)

(8) review of systems for signs of toxicity

(9) development of cancer


Organs which may be affected by antineoplastic agents include:

(1) bone marrow (anemia, thrombocytopenia with bruising, neutropenia with infection)

(2) gastrointestinal tract (diarrhea, bleeding, other)

(3) liver (hepatitis)

(4) urinary tract (cystitis with hematuria, nephrotoxicity)

(5) reproductive tract (infertility, miscarriage, abortion, teratogenic effect)

(6) skin (rash)


Laboratory tests used to screen the worker may include:

(1) complete blood count (CBC) with reticulocyte count

(2) liver function tests (transaminases, alkaline phosphatase, other)

(3) urinalysis with microscopic examination


Monitoring should be adapted to the person's risk. A person at minimal risk of exposure may not require additional testing, while a person with a history of significant exposure may require closer scrutiny.

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