doi: 10.56294/saludcyt2023568

ORIGINAL

Hematological alterations in farmers exposed to organophosphate pesticides

Alteraciones hematológicas en agricultores expuestos a plaguicidas organofosfatos

Francisco Poveda Paredes¹ *, Evelin Toapanta Toapanta² *, Victoria Cevallos Bonilla³ *, Daniela Rosero Freire⁴ *

¹Universidad Técnica de Ambato, Carrera de Laboratorio Clínico. Ambato, Ecuador.

Cite as: Poveda Paredes F, Rosero Freire DA, Cevallos Bonilla VM, Rosero Freire D. Hematological alterations in farmers exposed to organophosphate pesticides. Salud, Ciencia y Tecnología. 2023;3:568. https://doi.org/10.56294/saludcyt2023568

Submitted: 29-05-2023                       Revised: 10-07-2023                                       Accepted: 10-09-2023                       Published: 11-09-2023

Editor: Dra. Nairobi Hernández Bridón

ABSTRACT

Introduction: Organophosphates (OP) are one of the most widely used types of pesticides in the agricultural sector, their purpose is the control and elimination of pests. However, their indiscriminate use and lack of precaution when handling them can become a health risk for farmers.

Objective: to determine hematological alterations in farmers who are part of the Artisanal Association for the Production of Agricultural and Livestock Goods of Píllaro (ABAPP) exposed to organophosphate pesticides.

Methods: a quantitative and observational study was carried out with univariate and bivariate analysis. The study population consisted of 64 farmers, aged between 25 and 60 years, who are part of the ABAPP, of whom 56,3 % were women and 43,8 % were men.

Results: the data obtained showed statistically significant values in relation to the time of exposure to OP, in leukocytosis, neutrophilia and monocytopenia; while, in relation to the use of personal protective equipment, significant values were reported with the increase in red blood cells, increase in hematocrit, increase in hemoglobin, leukocytosis, neutrophilia and monocytopenia.

Conclusions: exposure to organophosphorus pesticides can cause health problems in agricultural workers.

Keywords: Organophosphates; Pesticides; Hematological Alterations.

RESUMEN

Introducción: los organofosforados (OP) son uno de los tipos de plaguicidas más utilizados en el sector agrícola, su finalidad es el control y eliminación de plagas. Sin embargo, su uso indiscriminado y falta de precaución al momento de manipularlos puede llegar a ser un riesgo en la salud de los agricultores.

Objetivo: determinar alteraciones hematológicas en agricultores que forman parte de la Asociación Artesanal de Producción de Bienes Agrícolas y Pecuarios del cantón Píllaro (ABAPP) expuestos a plaguicidas de tipo organofosforados.

Métodos: se realizó un estudio con enfoque cuantitativo y de tipo observacional, en donde se realizó análisis univariado y bivariado. La población de estudio estuvo constituida por 64 agricultores, con edades comprendidas entre los 25 a 60 años que forman parte del ABAPP, de los cuales el 56,3 % fueron mujeres y el 43,8 % fueron hombres.

Resultados: los datos obtenidos mostraron valores estadísticamente significativos con relación al tiempo de exposición a OP, en la leucocitosis, neutrofilia y monocitopenia; mientras que, en relación al uso de equipos de protección personal, se reportaron valores significativos con el aumento de glóbulos rojos, aumento de hematocrito, aumento de hemoglobina, leucocitosis, neutrofilia y la monocitopenia.

Conclusiones: la exposición a plaguicidas organofosforados si puede llegar a causar problemas en la salud de los trabajadores agrícolas.

Palabras claves: Organofosforados; Plaguicidas; Alteraciones Hematológicas.

INTRODUCTION

Organophosphates (OP) are organic compounds formed by esters of phosphoric acid. These compounds are used in different areas such as agriculture, mainly in the formulation of pesticides; petroleum additives, solvents, resins, artificial leather, inks, and insecticides.^(1,2)

In agriculture, the use of organophosphate pesticides has become a public health problem that affects the quality of life among farmers, for they are used indiscriminately and without biosecurity measures.⁽³⁾

According to interviews with workers, they manifest health problems due to these compounds, which have inhibitory action on acetylcholinesterase, present in nerve endings, resulting in alterations in the nervous system.⁽¹⁾

The main symptoms of exposure to OP are headaches, nausea, vomiting, excessive sweating, watery eyes and drooling, while in cases of intoxication, muscular weakness, heart rhythm alterations, bronchospasm leading to coma or even death develop.⁽⁴⁾ Furthermore, it has been observed that organophosphates can cause hematological alterations such as a decreased or increased in hemoglobin and hematocrit, a decrease in platelets and an increase in white blood cell, leading to various health problems.⁽⁵⁾

In developing countries, the lack of surveillance and regulation systems, non-compliance with biosecurity standards and lack of knowledge about the use of pesticide in the agricultural area make workers in these countries more vulnerable to suffer harmful health consequences due to prolonged exposure to organophosphates.⁽⁶⁾ In Ecuador, the agricultural area is of transcendental importance for the country's economy; in 2019, it had a contribution of 7,7 % of the GDP, being one of the sectors with the highest participation in the labor market.⁽⁷⁾

According to the Ministry of Public Health of Ecuador (MSP) in its annual report on the situation of pesticide poisoning in Ecuador, it detailed that in 2017 there were a total of 689 cases, in 2018 there were 425 cases, in 2019 there were 410 cases, in 2020 216 cases emerged and in 2021 173 confirmed cases were detected.⁽⁸⁾

In several communities in Ecuador, hematological studies have been conducted on agricultural workers in contact with OP, their results show neutrophilia, leukocytosis, increased red blood cells, lymphocytosis and variations in the number of platelets,⁽³⁾ in n their blood biochemistry, an increase in liver enzymes GGT, TGO - TGP, and a proportional decrease in erythrocyte cholinesterase according to the time in contact with the pesticide were found.⁽⁹⁾

The main purpose of this study was to identify alterations in the blood components of workers from the Artisanal Association of Agricultural and Livestock Goods Production in the Píllaro canton (ABAPP) and analyze their connection with continuous exposure to organophosphate pesticides, as well as the use of personal protective equipment (PPE) during their work activities. Additionally, the study aimed to establish the potential health consequences associated with the findings.

METHODS

Research approach

A descriptive observational study with a quantitative approach was carried out with a univariate and bivariate analysis with a significance level of 95%. The study population consisted of 65 patients who are part of the Artisanal Association of Production of Agricultural and Livestock Goods of Píllaro (ABAPP), chosen according to the inclusion and exclusion criteria, of the total participants, 59 patients were working with organophosphate pesticides at the time of the study, while 5 participants had previously worked with pesticides for more than 5 years, even though they were not currently working with them during the study period.

An analysis was conducted on the use of personal protective equipment (PPE), both complete and partial, taking into account the frequency with which it was used and the duration of exposure to organophosphate pesticides. The objective of this study was to determine if there is a relationship between contact with organophosphate pesticides, the full or partial utilization of personal protective equipment, and the hematological alterations found in the study population.

Inclusion Criteria

· Members of the ABAPP Association.

· Farmers exposed to organophosphate-type pesticides between the ages of 25 - 60 years old.

· Farmers exposed to organophosphate pesticides for 5 or more years.

· Farmers who agreed to participate in the study and voluntarily signed the informed consent form.

· Apparently healthy patients according to the exclusion criteria.

Exclusion criteria

· Patients with diagnosed hematological disorders.

· Patients on medication.

· Farmers with clinical symptoms at the time of sampling such as: general discomfort, fever, headache, paleness, cough, rhinorrhea.

· Farmers with ages outside the established range.

· Farmers exposed less than 5 years to organophosphate pesticides.

· Farmers who did not wish to participate in the study.

Population

The study population, previously selected by inclusion and exclusion criteria, was composed of 64 farmers members of the ABBAP Association who were exposed to organophosphorus pesticides.

Work Protocol

In order to carry out this research, the population of farmers who belonged to ABAPP was defined and a questionnaire was applied in order to collect information for the study and at the same time to know the toxicological data of the participants (annex 1).

A letter of consent was given, requesting their signature to authorize the handling of data and biological samples, and all doubts of the participants were answered.

The blood sample was extracted from each individual by venous puncture with a syringe, following the Biosafety protocols. The sample was whole blood taken in a tube with EDTA anticoagulant, the sample was analyzed by flow cytometry in the Hematological Counter Urit 3000 Plus, finally the results obtained were evaluated.

Digital tools

The data obtained were entered in Excel and analyzed by IBM-SPSS, which is a statistical software used for data analysis, elaboration of tables, graphs and statistical calculations.

Informed Consent

The research participants signed an informed consent form describing the objective of the study, the risks and benefits of participating, the procedures for handling the information and the collection of biological samples, thus authorizing the entire process. It should be emphasized that confidentiality and responsibility for the results obtained in the research were assured at all times. The persons accepted to participate in the study in an autonomous, free and conscious manner.

RESULTS

Socio-demographic characteristics of the population

Sixty-four farmers belonging to the ABAPP Association who met the inclusion criteria participated in this research. Each study participant filled out a survey to collect information on workplace conditions, use of personal protective equipment, and data on exposure to organophosphates.

According to the results of the survey, it was estimated that most of the participants were women (56,2 %) and men (43,8 %). In terms of age, there was a higher percentage of participants between 41 and 50 years of age, corresponding to 39,1 %, while farmers between 51 and 60 years of age accounted for 34,4 %. The population between 31 and 40 years of age represented 25 % of participants and the minority group between 21 and 30 years of age represented 1,5 %. The average age was 47,36 years.

Considering the educational level, it is estimated that 68,8 % of the farmers have primary education, followed by 28,1 % of the participants with secondary education and a lower percentage of those with higher education (3,1 %).

Exposure to organophosphate pesticides in agricultural workers

Table 1. Exposure to organophosphorus pesticides
Exposure Factor		n	%
Years as a farm worker	>10 years	56	87,5
	<10 years	8	12,5
Currently using OP pesticides	Yes	59	92,2
	No	5	7,8
Years using OP pesticides	>10 years	59	92,2
	>5 años <10 years	5	7,8
Frequency of use	Permanent	59	92,2
	Temporary	5	7,8
Last OP pesticide use	<2 years	61	95,3
	≥2 years	3	4,7
Uses OP pesticides at home	No	50	78,1
	Yes	14	21,9
Total		64	100

Table 1 shows the factors of exposure to organophosphate pesticides of the surveyed population; 87,5 % of the population has been engaged in agricultural work for more than 10 years, 92,2 % currently apply pesticides on a permanent basis for more than 10 years. A total of 95,3 % indicated that the last application of pesticides was within the last 2 years. It can also be seen that exposure occurs mainly at work, since most cases (78,1 %) do not use pesticides at home.

Use of personal protective equipment

In table 2, according to the use of PPE when handling pesticides, it can be observed that 64,1 % of the farmers use it constantly and 35,9 % never or occasionally use it. However, in the pesticide preparation process, 85,9 % of the study population does not use PPE. With regard to personal protective equipment, 78,1 % of the population uses gloves, 70,3 % uses masks for respiratory protection and the majority (81,3 %) does not use glasses to protect their eyes. On the other hand, the use of overalls to protect the body and the use of equipment to protect the head were used by 75,0 % of the farmers. Finally, 78,1 % of the study population used boots to protect their feet.

Table 2. Use of Personal Protective Equipment (PPE)
Form of use of PPE		n	%
Frequency of use	Always	41	64,1
	Never or occasionally	23	35,9
During pesticide mixing	Yes	9	14,1
	No	55	85,9
Hand protection	Yes	50	78,1
	No	14	21,9
Respiratory protection	Yes	45	70,3
	No	19	29,7
Protección ocular	Yes	12	18,7
	No	52	81,3
Protección corporal	Yes	48	75,0
	No	16	25,0
Protección para la cabeza	Yes	48	75,0
	No	16	25,0
Protección para los pies	Yes	50	78,1
	No	14	21,9
Total		64	100

Hematological Values

About 79,69 % of the population under study presented at least one hematological alteration and 20,31 % of the population did not present any hematological alteration.

Table 3 shows the values of the red blood cells (RBCs), the majority of the population presents a normal value with 70,3 %, 28,1 % of the surveyed workers present a high value and only 1,6 % show low values of erythrocytes. In connection with the hemoglobin value, the majority of the population presented normal figures (62,5 %), 26,6 % presented high levels, and low values were present in only 10,9 % of the agricultural workers surveyed. Similarly, hematocrit showed similar figures, with 67,2 % of people with normal values, 25,0 % with high values, and low values represented only 7,8 %.

The figures for mean corpuscular volume (MCV) were found to be 85,9 % normal, macrocytosis was present in 12,5 % and microcytosis in only 1,6 % of the population. For the mean corpuscular hemoglobin (MCH) values, 93,8 % were normal, 4,7 % showed hyperchromic erythrocytes and only 1,6 % showed hypochromia. In the Mean Corpuscular Hemoglobin Concentration (MCHC) 100 % of the population had normal values.

Table 3. Values of red blood cells, white blood cells and platelets
Parameters		n	%
Red blood cells (RBCs)	Low	1	1,6
	Normal	45	70,3
	High	18	28,1
Total		64	100
Hemoglobin (Hb)	Low	7	10,9
	Normal	40	62,5
	High	17	26,6
Total		64	100
Hematocrit (HCT)	Low	5	7,8
	Normal	43	67,2
	High	16	25,0
Total		64	100
MCV	Microcytosis	1	1,6
	Normal	55	85,9
	Macrocytosis	8	12,5
Total		64	100
MCH	Hypochromia	1	1,6
	Normal	60	93,8
	Hyperchromia	3	4,7
Total		64	100
MCHC	Low	0	0,0
	Normal	64	100,0
	High	0	0,0
Total		64	100
Platelets	Thrombocytopenia	0	0,0
	Normal	59	92,2
	Thrombocytosis	5	7,8
Total		64	100
White blood cells (WBCs)	Leukopenia	0	0,0
	Normal	52	81,3
	Leukocytosis	12	18,8
Neutrophils	Neutropenia	0	0,0
	Normal	51	79,7
	Neutrophilia	13	20,3
Lymphocytes	Lymphopenia	8	12,5
	Normal	51	79,7
	Lymphocytosis	5	7,8
Monocytes	Monocytopenia	36	56,3
	Normal	28	43,8
	Monocytosis	0	0,0
Eosinophils	Eosinopenia	0	0,0
	Normal	64	100,0
	Eosinophilia	0	0,0
Band neutrophils	Normal	64	100,0
Total		64	100
MCV: Mean Corpuscular Volume MCH: Mean Corpuscular Hemoglobin MCHC: Mean Corpuscular Hemoglobin Concentration

The platelet values were within the normal range in 92,2 % of the farmers tested, only 7,8 % presented thrombocytosis and none presented thrombocytopenia.

It is observed that 81,3 % of participants have a total leukocyte count with normal values, 18,8 % presented leukocytosis and there was no presence of leukopenia. On the other hand, 79,7 % of the population analyzed had a normal neutrophil count, 20,3 % had neutrophilia and none had neutropenia. Lymphocytes were found to be within normal values in 79,7 % of the participants, while there was lymphopenia in 12,5 % and lymphocytosis in 7,8 % of the farmers. In the case of monocytes, monocytopenia was present in 56,3 %, 43,8 % of the patients with normal values and monocytosis was not present in any case. Eosinophils were found to be normal in 100 % of the patients, as well as in the case of band neutrophils.

Bivariate Analysis - Years of exposure to OP - Red blood cells (RBCs), White blood cells (WBCs) and Platelets

Regarding the RBCs, no statistically significant values were found for the relationship between the years of exposure to OP and the values of red blood cells, hemoglobin, hematocrit and hematic indices.

In table 4, when comparing the years of pesticide use with the values of the WBCs and platelets, it can be seen that the group that has been using pesticides for more than 10 years represents 92,1 % of the group. By means of the Chi-square test, it can be observed that leukocytosis (p=0,006), neutrophilia (p=0,000) and monocytopenia (p=0,031), have a statistically significant relationship with the time of exposure due to the fact that when applying the test, p values of less than 0,05 are obtained.

In the case of lymphopenia (p=0,597) and lymphocytosis (p=0,498), no statistically significant values are shown in association with the years of exposure.

As for platelets through the chi-square test, thrombocytosis (p=0,460), does not have a statistically significant value.

Table 4. Correlation between years applying pesticides and white blood cell, platelets
Parameters		Years applying OP pesticides				Chi-square p=
		Less than 10 years		More than 10 years
		N	%	N	%
White blood cells	Leukopenia	0	0,0	0	0,0
	Normal	4	6,3	48	74,9
	Leukocytosis	1	1,6	11	17,2	0,006*
Total		5	7,9	59	92,1
Neutrophils	Neutropenia	0	0,0	0	0,0
	Normal	4	6,3	47	73,3
	Neutrophilia	1	1,6	12	18,8	0,000*
Total		5	7,9	59	92,1
Lymphocytes	Lymphopenia	1	1,6	7	10,9	0,597
	Normal	4	6,3	47	73,4
	Lymphocytosis	0	0,0	5	7,8	0,498
Total		5	7,9	59	92,1
Monocytes	Monocytopenia	2	3,1	34	53,1	0,031*
	Normal	3	4,8	25	39,0
	Monocytosis	0	0,0	0	0,0
Total		5	7,9	59	92,1
Platelets	Thrombocytopenia	0	0,0	0	0,0
	Normal	5	7,9	54	84,3
	Thrombocytosis	0	0,0	5	7,8	0,460
Total		5	7,9	59	92,1

Bivariate Analysis - Use of PPE - Red blood cells, White blood cells and Platelets

When performing the analysis of correlation between the use of personal protective equipment (PPE) and the values of the red blood cells, in Annex #4 it can be observed that statistically significant values are found for the high levels of erythrocytes (p=0,000), high Hb (p=0,000) and high HCT (0,000) in connection with the use of PPE. While in the case of low levels of erythrocytes (p=0,769), low Hb (p=0,667), low HCT (p=0,844), microcytosis (p=0,769), macrocytosis (p=0,922), hypochromia (p=0,769), hyperchromia (p=0,923), there is no statistically significant relationship between the mentioned variables.

Table 5. Correlation between the use of personal protective equipment with the values of white blood cells and platelets
Parameters		Use of personal protective equipment				Chi square p=
		Always		Never or occasionally
		n	%	N	%
White blood cells	Leukopenia	0	0,0	0	0,0
	Normal	33	51,6	19	29,6
	Leukocytosis	8	12,5	4	6,3	0,014*
Total		41	64	23	36
Neutrophils	Neutropenia	0	0,0	0	0,0
	Normal	32	50,0	19	29,6
	Neutrophilia	9	14,1	4	6,3	0,005*
Total		41	64	23	36
Lymphocytes	Lymphopenia	5	7,8	3	4,7	0,094
	Normal	33	51,6	18	28,1
	Lymphocytosis	3	4,7	2	3,1	0,243
Total		41	64	23	36
Monocytes	Monocytopenia	25	39,1	11	17,2	0,030*
	Normal	16	25,0	12	18,7
	Monocytosis	0	0,0	0	0,0
Total		41	64	23	36
Platelets	Thrombocytopenia	0	0,0	0	0,0
	Normal	38	59,4	21	32,8
	Thrombocytosis	3	4,7	2	3,1	0,243
Total		41	64	23	36

In comparison with the time of exposure to organophosphate pesticides and hematological alterations, statistically significant values p<0,05 were obtained for leukocytosis, neutrophilia and monocytopenia.

Table 6. Correlation between the use of PPE and alterations in the red blood cells
Parámeters		Use of personal protective equipment (PPE)				chi square p=
		Always		Never or occasionally
		n	%	N	%
Red blood cells	Low	0	0,0	1	1,6	0,769
	Normal	27	42,2	18	28,0
	High	14	21,9	4	6,3	0,000*
Total		41	64	23	36
Hemoglobin	Low	2	3,1	5	7,8	0,667
	Normal	26	40,6	14	21,9
	High	13	20,3	4	6,3	0,000*
Total		41	64	23	36
Hematocrit	Low	2	3,1	3	4,7	0,844
	Normal	27	42,1	16	25,0
	High	12	18,8	4	6,3	0,000*
Total		41	64	23	36
MCV	Microcytosis	0	0,0	1	1,6	0,769
	Normal	38	59,3	17	26,6
	Macrocytosis	3	4,7	5	7,8	0,922
Total		41	64	23	36
MCH	Hypochromia	0	0,0	1	1,6	0,769
	Normal	40	62,4	20	31,3
	Hyperchromia	1	1,6	2	3,1	0,923
Total		41	64	23	36
MCV: Mean Corpuscular Volume MCH: Mean Corpuscular Hemoglobin

DISCUSSION

The use of organophosphate pesticides in agriculture has become a public health problem that seriously affects the quality of life of farmers. These pesticides are used indiscriminately and without adequate biosafety measures.⁽³⁾

In this study we have found that the 79,69 % of farmers participating has at least one alteration in their blood components, while the 20,31 %, shows no hematological alteration.

In relation to the time of exposure to OP, the main hematological abnormalities found within the red series were the increase in red blood cell count with 28,1 %, increase in hemoglobin in 26,6 %, increase in hematocrit of 25 %, in addition it was shown that farmers exposed to pesticides presented macrocytosis and hyperchromia. However, the values obtained were not statistically significant by means of the chi-square measure, so there is no relationship between the variables analyzed.

Nevertheless, it has been seen that exposure to OP pesticides for a prolonged and permanent period of time can affect the hematological values of farmers, as supported by Esparza et al.⁽³⁾ in their study, where 31,5 % of the farmers exposed to organophosphates showed an increase in the number of red blood cells, 29,2 % of farmers showed an increase in the hemoglobin value, 26,2 % showed elevated hematocrit values, 10,2 % showed an increase in MCV and 6 % showed an increase in MCH.⁽³⁾ It is important to take into account that the increase in these hematological parameters is directly related to the diagnosis of polyglobulia causing headache, tinnitus, tingling sensation, dyspnea, hypersomnia, blurred vision, muscle pain and alterations in the state of consciousness; affecting the quality of life of the sufferer. ⁽¹⁷⁾

Regarding the values obtained in the analysis of the white series (table 4), it was observed that the main alterations presented by the farmers were leukocytosis, neutrophilia and monocytopenia. In these examinations, leukocytosis and neutrophilia showed statistically significant values according to the variables analyzed. These results correlate with the work of Nejatifar et al.⁽¹¹⁾, performed in workers of insecticide processing factories in India. The study was a case-control study with participants who were exposed and appeared healthy and with a group of participants who presented alterations in their leukocyte formula; leukocytosis and neutrophilia were reported with statistically significant values in the exposed group (P < 0,05).

This increase in the white series could be due to the immune response of the organism against exposure to pesticides in order to detect foreign substances without infectious character for their destruction, which can lead to a chronic inflammatory state.⁽¹²⁾

On the other hand, in our study, the exposed farmers presented monocytopenia with a statistically significant value (p<0,05), which differs from that found in the work of Fareed M et al.⁽¹³⁾, through a cross-sectional study carried out in 2 groups; group of 77 controls and exposed group formed by 166 pesticide sprayers working in mango orchards of Lucknow-India district. This study indicates that there was a statistically significant increase in monocytes (p < 0,001), establishing monocytosis as an indicator of chronic inflammation. However, the authors Huerta and Rodack, et al. ^{(14, 15)}, mention that a decrease in the number of red blood cells, granulocytes, platelets, and monocytes is associated with a deficiency in the production of blood cells (pancytopenia) in the bone marrow, caused as a consequence of biological or chemical factors such as exposure to radiation or the use of toxicological chemicals, such as organophosphorus pesticides.^(14,15)

In the case of platelets, the findings obtained are thrombocytosis in 4,3 % of farmers exposed to pesticides. As in the research conducted by Nejatifar et al.⁽¹¹⁾, a higher prevalence of thrombocytosis was observed in the exposed group (P < 0,05), than in the group that had not been exposed to pesticides. Thrombotic phenomena can lead to coagulation problems such as clot formation, bleeding, and in extreme cases, ischemia may occur.⁽¹⁷⁾

According to the use of personal protective equipment we observed that, when correlating with the values of red blood cells, hemoglobin and hematocrit (table 6), all these parameters were found to be increased. In addition, leukocytosis and neutrophilia were found in the white series (table 5). These alterations were related to the use of EPP with values of p<0,05, demonstrating that there is a significant association between the variables proposed in the research study.

Although in table 5 and table 6, a statistically significant relationship is observed between the use of PPE and the alterations found indistinctly between those who always and occasionally use PPE, we can sustain through the analysis of the surveys carried out that risk factors that increase the predisposition to alterations in blood cells due to exposure to organophosphates are evident. One of them is the lack of use of personal protective equipment during the preparation and mixing of these toxic products (table 2), when protection should be greater, since the farmer is in direct contact with the pesticide, generating an even higher risk of intoxication.

In addition, the use of personal protective equipment is not adequate, since PPE is partially used (table 2), identifying that they use a combination of 3 or 4 PPE equipment such as gloves, masks, boots, but do not use uniforms, goggles, caps, which counteracts compliance with biosafety measures. This shows that farmers give very little priority to the ocular mucosa, probably because they do not know that it is a main entry route for organophosphorus. ⁽¹⁸⁾

It should also be noted that they use disposable masks instead of masks with filters, thus increasing the risk.

Since this is a rural population, farmers have predominantly primary schooling (68,8 %), which could be related to their lack of knowledge of the effects that OPs can cause in the organism and, therefore, they do not take the necessary biosafety measures when using pesticides. Yánez⁽¹⁹⁾ in his research on OP poisoning in farmers where 40 % have primary education and 20 % have no education, also associates them with low knowledge of the correct way to handle pesticides, ignorance of the real risks to personal health and ignorance of the correct use of PPE.

Regarding the method of application of OP, the most used are the backpack with manual pump (89,1 %) and backpack with motor pump (82,8 %), with these types of application, the contact with the OP is direct, especially if PPE is not used to protect oneself in case of spilling the product or without considering the wind direction.

It can be perceived that the lack of personal protective equipment in the farmers' work would be the main risk factor for alterations to occur at the blood level, regardless of the time of exposure to OPs. This was evidenced by the fact that the farmers have been applying pesticides for a long time, no statistically significant relationship was found with the hematological alterations presented by the farmers, in contrast to what was found in relation to the use of PPE (p<0,05).

Dalbo et al.⁽¹⁷⁾, also reports similar findings, where leukocytosis and neutrophilia were present in 54,2 % of the fumigators who did not use PPE, both with values of p<0,05. These are considered as risk factors that increase the predisposition to alterations in blood cells due to exposure to organophosphates.⁽¹⁷⁾

Hematological alterations such as increased red blood cells, increased hemoglobin, increased hematocrit, leukocytosis, neutrophilia and monocytopenia can lead to different clinical manifestations affecting the quality of life of the sufferer.

It is concluded that exposure to OP is closely related to the hematological alterations present in ABAPP farmers, the main risk factor being the lack of use of PPE when handling them.

Study limitations

The main limitations in this study have been the selection of participants since many of the farmers, due to their level of education, did not want to participate in the study, in this way they will not adequately adapt to the demographic and occupational characteristics of the patients.

§ Exposure Measurement Difficulties: Accurately measuring exposure to organophosphates can be challenging, as exposure levels can vary over time and be influenced by multiple factors.

§ Long-Term Effects and Latency: Some adverse effects associated with exposure to organophosphates may have a long latency period, meaning that years may pass between the initial onset of effects.

§ Limitations on generalization: The results of a study may not be applicable to populations different from those studied or to different contexts, which limits the generalizability of the findings.

Logistical and compliance difficulties: coordination of blood sampling and follow-up of the participants was complicated, especially due to its social determinants

CONCLUSION

It is concluded that 79,7 % of the population of the Artisanal Association of Production of Agricultural and Livestock Goods of Píllaro (ABAPP) exposed to organophosphate pesticides has at least one hematological alteration in cell lines such as: increased red blood cell count, increased hemoglobin, macrocytosis, leukocytosis, neutrophilia and monocytopenia.

The risk factors that increase the probability of hematological alterations caused by exposure to OPs are the lack of use of personal protective equipment or its partial use during the mixing and use of pesticides, the lack of knowledge about the handling of OPs and the adverse effects they cause on health.

Farmers with polyglobulia, leukocytosis, neutrophilia and thrombocytosis can develop serious problems such as lack of tissue oxygenation, chronic inflammation and thrombotic problems, predisposing to alterations in the normal functioning of the organism, causing different health problems in ABBAP farmers.

REFERENCES

1. Fernández DG, Mancipe LC, Fernández DC. Intoxicación por organofosforados. Revista Med. 2010;18(1):84-92.

2. Carod Benedico E. Insecticidas organofosforados: De la guerra química al riesgo laboral y doméstico. Medifam. 2002;12(5):51-62.

3. Esparza-Olalla JE, Forero-Lugo FC, Mardones-Montanares MA. Uso de organofosforados por agricultores de la comunidad de Guaslán-Ecuador y los cambios hematológicos. Ciencia y Agricultura. 2020;17(1):31–50. https://doi.org/10.19053/01228420.v17.n1.2020.106034.

4. Morales Ovalles Y, Miranda de Contreras L, Di Bernardo Navas ML. Neurotoxicidad de los plaguicidas como agentes disruptores endocrinos: 2014;45(2):96-119.

5. Díaz V, Pistilli N, Guillén R, Melgarejo MD. Valores hematológicos en individuos expuestos accidentalmente a insecticidas organofosforados. Memorias del Instituto de Investigaciones en Ciencias de la Salud. 2002;1(1):01-04.

6. Coillo Contreras E. Cuidado de enfermería en paciente con intoxicación por órganos fosforados en el servicio de emergencia del hospital de apoyo de Puquio, junio 2017 [Tesis]. Arequipa: Universidad Nacional de San Agustín de Arequipa; 2017. http://repositorio.unsa.edu.pe/bitstream/handle/UNSA/2734/ENScccoek.pdf?sequence=1&isAllowed=y

7. Márquez J, Cuichán M. Encuesta de Superficie y Producción Agropecuaria Continua METODOLOGÍA. Quito - Ecuador. https://www.ecuadorencifras.gob.ec/documentos/web-inec/Estadisticas_agropecuarias/espac/espac-2020/Metodologia%20ESPAC%202020.pdf

8. Dirección Nacional de Vigilancia Epidemiológica. Efectos tóxicos año 2021 [informe]. https://www.salud.gob.ec/wp-content/uploads/2021/10/Gaceta-General-SEM-37-Intoxicaciones-por-Plaguicidas.pdf9.   

9. Cortés-Iza SC, Rodríguez AI, Prieto-Suarez E. Assessment of hematological parameters in workers exposed to organophosphorus pesticides, carbamates and pyrethroids in Cundinamarca 2016-2017. Revista de Salud Pública. 2017;19:468-474. https://doi.org/10.15446/rsap.v19n4.68092

10. Amaru Lucana, R. V. C. O. (2016). Guía para el diagnóstico y tratamiento de las eritrocitosis p 1.          Amaru Lucana R, Vera Carrasco O. Guía para el diagnóstico y tratamiento de las eritrocitosis patológicas en la altura. Revista Médica La Paz. 2016;22(2):70-77.atológicas en la altura. Rev Med La Paz, 22(2).

11. Nejatifar F, Abdollahi M, Attarchi M, Roushan ZA, Deilami AE, Joshan M, et al. Evaluation of hematological indices among insecticides factory workers. Heliyon. 2022;8(3):e09040. https://doi.org/10.1016/j.heliyon.2022.e09040

12. García C, Heredia C, Flores P, Parra C. El uso de los agrotoxicos y su afectación al sistema inmune: un tema de interés actual. Revista CON-CIENCIA. 2016;4(2):61-70. https://doi.org/10.16925/rdc.v4i2.117713. 

13. Fareed M, Pathak MK, Bihari V, Kamal R, Srivastava AK, Kesavachandran CN. Adverse respiratory health and hematological alterations among agricultural workers occupationally exposed to organophosphate pesticides: a cross-sectional study in North India. PLoS One. 2013;8(7):e69755. https://doi.org/10.1371/journal.pone.0069755

14. Huerta Aragonés J. Servicio de Pediatría. Sección de Hematología y Oncología Pediátricas. Hospital Materno-Infantil. Hospital General Universitario Gregorio Marañón. Madrid. https://www.aepap.org/sites/default/files/pags._507-528_hematologia_practica.pdf

15. Rodak B, Fgke. Hematología Fundamentos y aplicaciones clínicas. 4a ed. Panamericana; 2014.

16. Carrillo-Esper R, Garnica-Escamilla MA, Ramírez-Rosillo FJ. Trombocitosis. Médica Sur. 2018;20(4).

17. Dalbó J, Filgueiras LA, Mendes AN. Effects of pesticides on rural workers: haematological parameters and symptomalogical reports. Ciencia & saude coletiva. 2019;24:2569-2582. https://doi.org/10.1590/1413-81232018247.19282017

18. Ulibarry González P. Efecto de los plaguicidas sobre la salud humana Exposición e impactos. Biblioteca del Congresp Nacional de Chile/ BCN. 2019.from:https://obtienearchivo.bcn.cl/obtienearchivo?id=repositorio/10221/26823/2/Efecto_de_los_plaguicidas_en_la_Salud.pdf

19. Yánez Toapanta P. Medidores bioquímicos para intoxicación en agricultores expuestos a organofosforados en la parroquia san miguelito delcantón píllaro. [Tesis]. Universidad técnica
DE AMBATO; 2020. https://repositorio.uta.edu.ec/bitstream/123456789/30803/2/tesis-finalmarcadores-bioquimicos-para-intoxicaci%c3%93n-pororg.pdf

FINANCING

The authors received no funding for the development of this.

CONFLICT OF INTERESTS

The autors declare that does not exist an interest conflict.

AUTHORSHIP CONTRIBUTION

Conceptualization: Francisco Xavier Poveda Paredes.

Data curation: Daniela Alexandra Rosero Freire.

Formal analysis: Daniela Alexandra Rosero Freire.

Fundraising: Francisco Xavier Poveda Paredes, Daniela Alexandra Rosero Freire, Evelyn Aracely Toapanta Toapanta, Victoria Maritza Cevallos Bonilla.

Research: Francisco Xavier Poveda.

Methodology: Victoria Maritza Cevallos Bonilla.

Project administration: Daniela Alexandra Rosero.

Software: Victoria Maritza Cevallos Bonilla.

Supervision: Daniela Alexandra Rosero.

Validation: Daniela Alexandra Rosero.

Visualization: Daniela Alexandra Rosero.

Writing – original draft: Francisco Xavier Poveda Paredes, Evelyn Aracely Toapanta Toapanta.

Writing – review and editing: Daniela Alexandra Rosero.

Supplementary Material

Supplementary Material 1 Questionnaire to evaluate exposure to organophosphate pesticides in agricultural workers.