Measurement of Benzene Levels in Decrease Hemoglobin Levels

among Printing Industry Workers

Anggi Isnani Parinduri

, Taufik Ashar

, Nurmaini

, Irmayani

, Annisa Febriana Siregar

and Samuel

Marganda Halomoan Manalu

Institut Kesehatan Medistra Lubuk Pakam, Indonesia

Faculty of Public Health, University of Sumatera Utara, Indonesia

Institut Kesehatan Deli Husada Deli Tua, Indonesia

Keywords: Benzene, Hemoglobin level, Printing Industry

Abstract: The printing industry used chemicals that are harmful to the environment and humans, one of which is a

volatile organic compound is benzene, was used as an ink solvent. The effect on the health of workers is

damage to the blood formation system (bone marrow), which can pose a risk of a decrease in the number of

elements of the blood cell which include a decrease in hemoglobin levels. The population is 50 workers

from 6 printing industry, samples were taken by consecutive sampling techniques. The results showed that

workers who were exposed to benzene and had decreased hemoglobin levels by 17 people. Chi square test

showed a correlation between long of exposure and benzene levels with anemia. The results of multiple

logistic regression test showed that the levels of benzene most afected on anemia, benzene levels had a

chance 44,5% to affected with anemia. Advice for workers should use Personal Protective Equipment (PPE)

such as masks chemical cartridge types, optimizing the air vents and turn on the exhaust fan. For owners of

printing should be able to provide appropriate PPE. For the Department of Labor can make policy and

monitor existing regulations.

1 INTRODUCTION

The printing industry used chemicals that are

harmful to the environment and society, one of

which is the volatile organic compounds released

from the printing process, especially in cleaning

materials, inks and other solutions to wet the

printing plate. Benzene was used as an ink solvent.

Chronic exposure to benzene can cause bone

marrow damage and decrease in hemoglobin levels.

Benzene is a carcinogenic substance (cause of

cancer) to workers or humans exposed.

Epidemiological studies prove the relationship

between exposure to benzene derived from solvents

containing benzene with the incidence of acute

myelogenous leukemia (AML). Damage to the

systemimmune also occur on exposure to benzene

through inhalation. This is shown by the decrease in

the number of antibodies and decreasing the number

of leukocytes in workers who are exposed (ATSDR,

2007).

The most systemic effect produced on chronic

and moderate benzene exposure is the failure of red

blood cell formation. The initial biomarker for low

levels of benzene exposure is a reduction in the

number of blood cells. The usual clinical finding in

benzene hematoxicity is cytopenia, which is a

decrease in the elements contained in blood cells

that cause anemia, leukopenia, or thrombocytopenia

in humans and animal experiments. Benzene can

cause damage in a very dangerous body called

aplastic anemia, which is where the body fails to

form red blood cells due to damage to the bone

marrow that produces blood cells. This aplastic

anemia is an early indication of acute non-

limphocytic leukemia (acute non-lymphocyte

leukemia).

Benzene absorption pathway through breathing,

skin or eye mucosa. Chronic effects of benzene

exposure are damage to the blood formation system

(bone marrow) which can pose a risk of reducing the

number of elements of the blood cell including a

decrease in hemoglobin levels (Mahawati et al,

2006).

The most significant health effects of benzene

exposure in the short and long term are

hematoxicity, immunotoxicity, neurotoxicity, and

Parinduri, A., Ashar, T., Nurmaini, ., Irmayani, ., Siregar, A. and Manalu, S.

Measurement of Benzene Levels in Decrease Hemoglobin Levels among Printing Industry Workers.

DOI: 10.5220/0009466000970104

In Proceedings of the International Conference on Health Informatics and Medical Application Technology (ICHIMAT 2019), pages 97-104

ISBN: 978-989-758-460-2

carcinogenicity. In addition, there are three types of

effects on bone marrow due to benzene exposure,

namely bone marrow depression that leads to

aplastic anemia, changes in cromosomes, and

carcinogenicity (IPCS EHC 150, 1993).

Benzene exposure can occur in the printing

industry, shoe making, rubber processing, and

raincoat manufacturing in its chemical processes.

The main exposure is through inhalation, although

dermal exposure (contact with skin) is also possible.

Health effects are divided into several exposures,

depending on the duration or length of exposure.

Acute exposure (≤ 14 days), intermediate exposure

(15-364 days), and chronic exposure (365 days or

more) (Rendi, N.S, 2012).

Repeated chronic benzene exposure even in low

concentrations can cause various blood disorders,

namely anemia, aplastic anemia, thrombocytopenia,

pancytopenia, and acute leukemia (Hays et al, 2012).

Exposure to benzene with high levels through

inhalation (breathing) can cause death, while

exposure to low doses causes dizziness, rapid

heartbeat, headache, tremor, confusion and out of

focus. If ingested or consumed ingredients with high

benzene content can cause coughing, hoarseness,

and burning sensation in the mouth, pharynx and

esophagus, stomach irritation, excessive drowsiness,

and ultimately death. Neurological effects have been

reported in humans exposed to high levels of

benzene. Fatal exposure through inhalation causes

vascular congestion in the brain. Chronic inhalation

exposure can cause distal neuropathy, insomnia, and

memory loss. Oral exposure has the same effect as

exposure through inhalation. Animal studies suggest

that exposure to benzene through inhalation results

in reduced electrical activity in the brain, loss of

reflexes, and tremors.

Exposure to benzene through the skin does not

cause nerve damage. Acute exposure through oral

and inhalation with high benzene levels can cause

death, which is associated with central nervous

system (CNS) depression. Chronic low-level

exposure is related to effects on the peripheral

nervous system. Chronic exposure to benzene causes

greater toxicity than acute exposure, because this

exposure can occur at levels below the odor

threshold. More exposure to the work environment

through breathing (inhalation), in addition to through

ingestion (swallowed) and through the skin.

Symptoms and signs of chronic poisoning can

appear quickly, but the latent period of benzene is as

long as 29 years, from the last exposure until the

toxicity in the body disappears (Hamilton, 2003).

High concentrations of benzene exposure have a

narcotic effect on the central nervous system (CNS).

Acute effects include mild dizziness, headaches,

excitement, unstable gait, euphoria, confusion,

nausea, vertigo, and drowsiness. If exposure

continues, it can cause seizures until death.

Inhalation is the most common route of exposure,

but skin exposure can cause edema, burning, and

blisters (Harbison et al, 2015).

Repeated and prolonged chronic exposure to

benzene at work, even in low concentrations, can

cause a variety of blood disorders that vary from

anemia, thrombocytopenia, aplastic anemia,

pancytopenia, and acute leukemia (Hays et al, 2012).

Anemia is a condition when the body lacks red

blood cells or the concentration of hemoglobin in the

blood is insufficient so that there is a disruption in

transporting oxygen throughout the body. Anemia

indicator for age > 15 years is when blood Hb

(hemoglobin) concentration is < 12 mg / dL in

women and < 13 mg / dL in men (Tarwoto and

Wartonah, 2008). Anemia can be detected through

symptoms that appear like pale, easily tired,

palpitations, tachycardia (faster heart beat) and

shortness of breath (Arisman, 2004). Other

complaints are dizzy, lethargic, dizzy and easily

drowsy. Prolonged anemia will cause decreased

work productivity and organ damage.

In Indonesia there are many health cases due to

exposure to benzene in the air. The health effects of

benzene exposure on bodyworkers who use benzene

as a paint solvent, found that 42,9 percent of

respondents experienced excessive benzene

exposure and there were cases of anemia by 68,9

percent (Mahawati, 2006).

Results of research on workers Mixing Plastic

Packaging Industry Operators at PT. X shows that

there is a relationship between the duration of

benzene exposure with blood hemoglobin levels in

workers. Prevalence Ratio Analysis shows that the

duration of benzene exposure (RP = 2,2 ) is a risk

factor for a decrease in blood hemoglobin level

(Sukmavita, 2006).

Research conducted in the Petroleum Processing

Industry found that there was a significant

relationship between benzene levels and the blood

profile of Hemoglobin. Exposure to benzene is a

major source of disruption to the profile of blood in

the form of interference against concentration

hemoglobin (Ramon, 2007).

Based on initial surveys that have been carried

out in several printing companies in the city of

Medan, it was found that the number of workers in

the production section numbered 15 people with an

ICHIMAT 2019 - International Conference on Health Informatics and Medical Application Technology

average of 9 hours work hours, overtime workers

when there is a piece that must be completed within

a certain time. The condition of the workplace is

closed and there is an air conditioner that is always

turned on, a very pungent odor is emanating from

the production room to the outside of the room, in

the room there is no ventilation for air exchange so

workers keep inhaling the aroma, workers out of the

room only during recess. Some workers wear

Personal Protective Equipment (PPE) in the form of

medical masks, workers complain the smell is still

smelled even though wearing PPE because it is not

in accordance with the potential hazards at work.

Measurement of benzene in the working

environment uses a Gas Chromatography

measurement tool with a Flame Ionization Detector

and refers to the 1501 method (NIOSH, 1994).

Measurement of hemoglobin levels using a Portable

Hemoglobin Meter.

2 RESEARCH METHODS

The locations of the printing industry in the city of

Medan which are the sampling places in this study

were in the District of Medan Baru, Medan Area and

Medan Selayang.

Here are the locations of the printing industry in

the city of Medan which is where sampling in this

study are:

Table 1: Location of The Printing Industry.

Printing industry Research sites

Printing Industry 1 Medan Barat District

Printing Industry 2 Medan Sunggal District

Printing Industry 3 Medan Barat District

Printing Industry 4 Medan Sunggal District

Printing Industry 5 Medan Barat District

Printing Industry 6 Medan Area District

The sample in this study amounted to 50 workers

were taken from 6 the printing industry. Samples

were taken by consecutive sampling technique by

means of researchers going to each printing industry

in the study location until the number of samples is

met. Every worker who meets the inclusion criteria

will be included as a research subject.

The inclusion criteria in this study are as follows:

workers who have worked for at least 1 year, are

willing to be the subject of research by signing the

consent form. Exclusion criteria are workers who

suffer from diabetes mellitus, kidney failure and

malignancy, workers who have the habit of taking

vitamin supplements routinely every day, and female

workers who are menstruating and pregnant.

The univariate analysis conducted was useful to

see the frequency distribution in categorical data

such as age, sex, long of exposure, length of service,

levels of benzene in the workplace air, health

complaints, smoking habits, use of PPE and anemia.

Bivariate analysis was carried out to determine

the relationship between the independent variable

and the dependent variable. Bivariate analysis used

is the chi square test used for categorical data with

categorical data, if it meets the requirements used

Pearson chi square and if it does not meet the

requirements used Fisher's Exact.

Multivariate analysis aims to analyze the

relationship of several independent variables with

one dependent variable. Multivariate analysis is used

is a multiple logistic regression test, one of the

mathematical models approaches to analyze the

effects of several independent variables on

categorical dependent variables, to find out which

independent variables are more closely related to the

dependent variable.

Primary data were obtained from interviews

using a structured questionnaire to obtain

demographic data of research subjects including

other ages, sex, and years of service. Data on worker

habits regarding use of personal protective

equipment during work, smoking habits, length of

exposure to benzene chemicals in the work space

and health complaints data will also be obtained

from interviews with questionnaires.

Measurement of benzene in the air refers to the

method in 1501 (NIOSH, 1994). Examination of

ambient air samples for the measurement of benzene

was carried out at the Laboratory Center of

Occupational Health and Safety. Sampling was done

with a sampler in the air (air sampler instrument)

pengabsorb material in the form of activated carbon

(coconut shell carchoal). The steps of air sampling

method is as follows:

1. Air sampling by using a simple vacuum pump

connected by a glass tube containing activated

carbon (coconut shell charcoal), which is placed at

the points specified by the velocity (flowrate) 0,2

liter / min for 30 minutes in accordance with the

provisions of NIOSH method 1501

Measurement of Benzene Levels in Decrease Hemoglobin Levels among Printing Industry Workers

2. The activated carbon that already contains

benzene taken to the laboratory for analysis

3. The tube contains activated carbon and activated

carbon solved dissolved in CS2 solution that will

extract the benzene contained in activated carbon are

then injected into the Gas Chromatography

4. Gas Chromatography was used equipped with a

flame detector ionitation

5. The solution will be driven by gas injection

(carrier gas) through a capillary tube (column oven)

6. Benzene will reach the detector at the time and on

the detector will be seen outside of the peak of

benzene were then compared with a standard to

obtain the concentration of benzene.

Measurement of hemoglobin concentration in the

blood using the Portable Hemoglobin Meter. Tools

and materials used namely Hemoglobin Meter

Portable Easy Touch, Strip Hemoglobin Easy

Touch, Pen Lancet, Lancet Needles, Alcohol swabs

and wipes. The inspection measures hemoglobin

levels in workers is as follows:

1. Health workers turned Hb Meter Portable tools

Easy Touch

2. Officers enter into the tool Portable Strip Hb

Hemoglobin Meter Easy Touch

3. The clerk swiped / cleaning tip ring finger or

middle finger with alcohol swab workers

4. The officer poked his fingertips worker with pen

sterile lancet, lancet needle is replaced with a new

lancet needle and every worker uses a different

needle and sterile lancet

5. The clerk pressed a fingertip has been punctured,

the first blood smear is coming out with a tissue

6. Take the next blood, and then insert it into the

Strip hemoglobin that has been put into the Hb

Portable Meter Easy Touch

7. Wait ± 10-15 seconds, then the officer noted the

number that appears on the monitor.

Figure 1: Measuring Levels of Benzene in the Air

Working Environment

Figure 2: Measurement of hemoglobin concentration on

Workers

3 RESULTS AND DISCUSSION

The results of research in 6 printing industries found

2 printing industries which have benzene levels that

pass through the threshold value of 1.5602 mg/m³

and 0.9366 mg/m³, and the printing industry which

has the lowest benzene content in the printing

industry 6 is 0.0662 mg/m³. Based on the

measurement results obtained above it can be seen

that there is a very big difference between the

measurement results under the threshold value and

the measurement results above the threshold value,

this is certainly due to differences in the levels of

benzene in each printing industry that is influenced

by several factors including: types of raw materials

used, work methods and work methods in the

printing industry, the amount of production

produced, and the condition of the space in the

printing industry.

ICHIMAT 2019 - International Conference on Health Informatics and Medical Application Technology

100

Table 2: Location and Description of the Work

Environment.

Printing Name

Benzene

levels in

the air

(mg/m³)

Ventilation Systems,

Printing Machine and

Room Size

Printing 1

(DD)

1,5602

Offset printing, the

machine used was 4, and

there is no ventilation. Size

9x4 meter room.

Printing 2

(DPI)

0,9366

Digital printing, the

machine used was 2, with

air conditioner, and there is

an exhaust fan but it is not

used.

Size 7x5 meter room.

Printing 3

(SKL)

0,4523

Digital printing, the

machine used was 1, no

ventilation, doors and

windows are always open.

Size 7x8 meter room.

Printing 4

(TDP)

0,1575

Digital printing, the

machine used was 1, with

air conditioner, and no

exhaust fan.

Size 6x6 meter room.

Printing 5

(AK)

0,0718

Offset printing, the

machine used was 5, the

main door is always open

as the air exchange. Size

14x5 meter room.

Printing 6

(RGR)

0,0662

Digital printing, the

machine used was 1, the

main door is always open

as air exchange, and there

is a fan.

Size 5x4 meter room.

Based on observations in several printing

industry production rooms using Air Conditioner

(AC) and no exhaust fans , while 4 other printing

industries did not pass through the threshold value

because some printing already use exhaust fans,

ventilation sufficient with the opening of the main

door of printing and windows in production room,

and other things are caused when air measurements

took place the printing industry was not doing the

production process.

The number of respondents in the printing

industry in this study amounted to 50 people.

Characteristics of respondents consisted of: age,

gender, long of exposure, years of service, health

complaints, smoking habits and the use of personal

protective equipment (PPE).

Respondents aged ≥ 29 years were 25 people

(50%) and aged < 29 years were 25 people (50%).

The majority of male gender is 38 people (76%).

The majority of long exposure > 8 hours is 35

people (70%). The majority of work period ≥ 2 years

is 36 people (72%). The majority of worker’s

smoking habits are those who do not smoke as many

as 33 people (66%). The majority of PPE uses are

those that do not use as many as 43 people (86%).

Table 3: Distribution Characteristics of Printing Industry

Workers.

Characteristics of Workers n = 50 %

Age

≥ 29 years

<29 years

Gender

Male

Female

Long of Exposure

> 8 hours

≤ 8 hours

Work Period

≥ 2 years

<2 years

Health Complaints

Yes

Smoking Habit

Yes

Use of PPE

Yes

The most benzene levels were ≤ 0.5 mg/m³ as

many as 32 people (64%) and > 0.5 mg/m³ as many

as 18 people (36%). The majority of workers who

were not anemia were 33 people (66%) and those

who anemia were 17 people (34%).

Table 4: Frequency Distribution of Benzene and Anemia.

Variables n = 50 %

Benzene Levels

> 0,5 mg / m³

≤ 0,5 mg / m³

Anemia

Yes

Measurement of Benzene Levels in Decrease Hemoglobin Levels among Printing Industry Workers

101

Table 5 shows that there was no correlation

between age with anemia (p = 0,370 > α = 0,05).

There was no correlation between gender with

anemia (p = 0,294 > α = 0,05). There was correlation

between long of exposure with anemia (p = 0,001 <

α = 0,05). There was no correlation between work

period with anemia (p = 0,099 > α = 0,05). There

was no correlation between benzene levels with

anemia (p = 0,016 < α = 0,05). There was no

correlation between health complaints with anemia

(p = 0,344 > α = 0,05). There was no correlation

between smoking habit with anemia (p = 0,890 > α =

0.05) and there was no correlation between use of

PPE with anemia (p = 0,677> α = 0,05).

Table 5: Relationship between Age, Gender, Long of

Exposure, Work Period, Benzene levels, Health

complaints, Smoking Habit and Use of PPE with Anemia.

Variables

Anemia

p.value

Yes No

n % n %

Age

≥ 29 years

10 40,0 15 60,0 0,370

< 29 years 7 28,0 18 72,0

Gender

Male 11 28,9 27 71,1 0,294

Female 6 50,0 6 50,0

Long of Exposure

> 8 hours 17 48,6 18 51,4 0,001

≤ 8 hours 0 0 15 100

Work Period

≥ 2 years 15 41,7 21 58,3 0,099

< 2 years 2 14,3 12 85,7

Benzene Levels

> 0.5 mg / m³ 10 55,6 8 44,4 0,016

≤ 0.5 mg / m³ 7 21,9 25 78,1

Health Complaints

Yes 8 42,1 11 57,9 0,344

No 9 29,0 22 71,0

Smoking Habit

Yes 6 35,3 11 64,7 0,890

No 11 33,3 22 66,7

Use of PPE

No 14 32,6 29 67,4 0,677

Yes 3 42,9 4 57,1

Based on the results of research from 50

respondents there were 17 people (48,6 %) who

were anemia with a long of exposure above 8 hours

per day. Based on the analysis results obtained p

value of 0,001 (p < 0,05 ), which means there is a

significant relationship between long of exposure

with anemia. The long of exposure is related to the

magnitude of the effect that will be caused because

the long of exposure will affect the amount of

concentration of benzene that enters the body and

causes anemia, if the longer and often the worker is

exposed to benzene, the greater the risk and chronic

effects on health that arise. Therefore OSHA sets an

exposure limit of 8 hours a day or 40 hours a week.

The results of the study are in line with the

research of Sukmavita (2006) on the Plastic

Packaging Industry Mixing Operator workers at PT.

X which shows that there is a relationship between

long of exposure with blood hemoglobin levels in

workers. Prevalence Ratio Analysis shows that the

duration of benzene exposure (RP = 2,2 ) is a risk

factor for a decrease in blood hemoglobin levels that

causes anemia.

Table 6: Relationship between Long of Exposure with

Anemia.

Variable p

(95% CI)

Long of Exposure

> 8 hours

≤ 8 hours

0,001

0.514

(0.373 to

0.71)

The results showed that of the 50 workers in the

printing industry with the most anemia > 0.5 mg/m³

as many as 10 people and below or equal to 0.5

mg/m³ as many as 7 people. Chi square test results

obtained p value of 0.016 (p < 0.05 ), which means

there is a significant relationship between benzene

levels with anemia. This study is in line with the

results of the National Cancer Institute (NCI)

research indicating that workers who are chronically

exposed to benzene below 10 ppm are 2,6 times the

tendency to experience haematological disorders (all

types of neoplasms) (ATSDR, 2007).

Table 7: Relationship between Benzene Levels with

Anemia.

Variables p

(95% CI)

Benzene Levels

> 0.5 mg / m³

≤ 0.5 mg / m³

0,016

2,54

(1.171 to

5.508)

ICHIMAT 2019 - International Conference on Health Informatics and Medical Application Technology

102

Benzene enters the body in the form of steam

through inhalation and absorption mainly through

the lungs, the amount of benzene vapor inhaled is

around 70-80% of the total amount of benzene that

enters the body. Benzene is easily absorbed through

the respiratory tract with a percentage of 70-80% in

the first 5 minutes, and 20-60% until the next hour

(ATSDR, 2007). The main target of benzene

exposure in humans is the spinal cord, which is the

site of formation of blood cells. Benzene can cause

the spinal cord to be disrupted so that it will result in

disruption of the process of making blood cells and

ultimately cause health effects due to abnormal

blood cells in humans, such as anemia (CDC, 2005).

Based on the results of multivariate analysis with

multiple logistic regression tests it is known that the

variable levels of benzene affect anemia, with

significance values (p = 0.019) and Exp (B) = 4.464.

Levels of benzene chance to anemia by 44,5 % and

the rest is influenced by other factors not included in

this study variables.

Table 8: Effects of Benzene Levels on Aanemia.

Variable Koef. B Exp (B) p

Benzene

levels

1,496 4.464 0,019

Constant -1.719

The results of research from 6 printing industries

found 2 printing industries that passed through the

TLV or as many as 10 people (55,6 %) workers were

anemia with benzene levels more than 0.5 mg/m³,

and 4 other printing industries did not pass through

the TLV due to already using exhaust fan, good

ventilation with the opening of the main printing

door and when the measurement takes place the

printing industry is not doing the production process.

Some ways to reduce the level of benzene in the

workplace air is by opening all the windows, doors

or vents available, thereby maximizing the exchange

of air that is in the workplace. In addition, if it is

possible for the production process to be carried out

in an open area such as on the veranda of a house or

if in a closed room and using air conditioning, it

should be given an exhaust fan in the workspace.

Optimization of ventilation should be a priority

target for changes in exposure to benzene vapors in

the printing industry. The use of personal protective

equipment (PPE) must also be in accordance with

potential hazards in the workplace, so that benzene

vapors are not directly exposed by workers in the

production room.

4 CONCLUSION

1. The measurement results of benzene in the air of

the working environment of the printing industry

that exceeds the threshold value according to

Permenaker RI No. 5 2018 which is equal to 0,5

mg/m³. From 6 printing industries, there are 2

printing industries which pass threshold value,

namely printing industry 1 at 1,5602 mg/m³ and

printing industry 2 at 0,9366 mg/m³.

2. A total of 50 printing industry workers were the

subject of research, there were 38 people (76%)

were male and 12 people (24%) were female, the

majority of the duration of > 8 hours of exposure

were 35 people (70%), working period ≥ 2 years

totaling 36 people (72%), there were no health

complaints totaling 31 people (62%), no smoking

totaling 33 people (66%), and not using PPE totaling

43 people (86%).

3. Workers who have anemia are 17 people (34%)

out of 50 workers who are respondents. Workers

who experienced anemia were 11 men (28,9 %) and

6 women (50%).

4. Chi-square test results showed a significant

relationship between duration of exposure with

anemia with a p value of 0.001 (p < 0,05 ) and there

was a significant relationship between benzene

levels with anemia with a p value of 0.016 (p <0,05).

5. The results of the multiple logistic regression test

showed that the levels of benzene most influence on

anemia, levels of benzene chance to anemia by 44,5

5 SUGGESTION

1. For Workers

Workers can increase knowledge about health in

the workplace by using PPE in the workplace to

minimize exposure to benzene that enters the

worker's body, such as use Chemical Cartridge

type masks, optimizing air vents and turn on the

exhaust fans

2. For Owners

Owners of printing should carry out periodic

health checks, provide appropriate PPE and

make rules or sanctions if workers are negligent

and do not use the PPE provided, and perform a

work rotation system.

3. For the Department of Labor

The Manpower Office can make policy and

monitor existing regulations.

Measurement of Benzene Levels in Decrease Hemoglobin Levels among Printing Industry Workers

103

REFERENCES

Agency for Toxic Substances and Disease Registry

(ATSDR), 2007. Toxicological profile for benzene.

U.S. Department of Health and Human Services.

Public Health Service Agency for Toxic Substances

and Disease Registry diakses 24 November 2017

https://www.atsdr.cdc.gov/ToxProfiles/tp3.pdf

Arisman, M.B. 2004. Buku ajar ilmu gizi: gizi dalam daur

kehidupan. Jakarta: EGC.

CDC. 2005. Facts About Benzena. Diakses 17 November

2017

http://www.bt.cdc.gov/agent/benzene/basics/facts.asp.

Fathonah, Y. I. 2010. Analisis risiko kesehatan paparan

benzen pada pekerja bengkel sepatu "x" di kawasan

perkampungan industri kecil (PIK) pulogadung.

Jakarta Timur. Depok: Universitas Indonesia.

Hamilton, R.J., Phillips, S.D., McCluskey, G.J., 2003.

Occupational, Industrial, and Environmental

Toxicology, 2nd.ed., Mosby Inc, Pensylvania.

Harbison, R.D., Bourgeois, M.M., Johnson, G.T., 2015.

Hamilton & Hardy’s Industrial Toxicology, Sixth

Edition, USA: Wiley.

Hays, M.S., Pyatt, D.W., Kirman, C.R., and Aylward, L.L.

2012. Bioavaibility equivalents for benzena. Regul

Toxico Pharmacol, 62(1): 62-73.

IPCS (International Programme on Chemical Safety).

1993. Environmental health criteria 150 benzene,

Geneva: World Health Organization.

Mahawati, E., Suhartono, Nurjazuli. 2006. Hubungan

antara kadar fenol dalam urin dengan kadar hb,

eritrosit, trombosit dan leukosit (studi pada tenaga

kerja di industri karoseri CV. Laksana Semarang)”, J

Kesehatan Lingkungan Indonesia Vol. 5 No.1, April

2006.

Ramon, A. 2007. Analisis paparan benzena terhadap profil

darah pada pekerja industri pengolahan minyak bumi.

Tesis. Universitas Diponegoro, Semarang.

Rendi, N.S. 2012. Analisis resiko kesehatan paparan

benzene pada karyawan di SPBU X Pancormas Depok

Tahun 2011. Skripsi. Jakarta: Fakultas Kesehatan

Masyarakat Program Studi Kesehatan Masyarakat

Departemen Keselamatan dan Kesehatan Kerja

Depok.

Sukmavita, A. 2006. Besar risiko lama pemaparan

senyawa benzene terhadap kadar hemoglobin darah

pada tenaga operator mixing industri kemasan plastik

di PT. X Semarang. Skripsi. Universitas Diponegoro,

Semarang.

Tarwoto, Wartonah. 2008. Keperawatan medikal bedah

gangguan sistem hematologi, Jakarta: Trans Info

Media.

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