{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T14:42:17Z","timestamp":1786632137866,"version":"build-2736575974"},"reference-count":23,"publisher":"American Chemical Society (ACS)","issue":"11","license":[{"start":{"date-parts":[[2017,12,29]],"date-time":"2017-12-29T00:00:00Z","timestamp":1514505600000},"content-version":"vor","delay-in-days":4152,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2006,11,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Context<\/jats:title>\n                    <jats:p>Although there are ample data on the respiratory effects of exposure to fire extinguisher gas, the potential hematologic effects have not been fully documented. We conducted this study to determine the possible etiologic agent(s) for a decrease in red blood cells among community residents in Taipei, Taiwan, after they were exposed to leakage of mixed fire extinguishants containing bromotrifluoromethane (CF3Br, Halon 1301), bromochlorodifluoromethane (CF2BrCl, Halon 1211), and dichlorodifluoromethane (CCl2F2, CFC-12).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>We studied 117 exposed residents who came into one hospital for physical examinations. We also selected age- and sex-matched referents for comparison from residents who came to the same hospital for health examinations. Nine months after the exposure to mixed fire extinguishants, 91 of the exposed residents came back for a second physical examination. In the first examination of the exposed residents, we found a significant reduction in red blood cell count and hemoglobin and a relationship between dose and response.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>After excluding iron-deficiency anemia, thalassemia, and other possible agents, we suspected that the hematologic effects might have resulted from pyrolytic products of CFC-12 and Halon 1211, which may contain phosgene, among other products.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Relevance to clinical practice<\/jats:title>\n                    <jats:p>The acute transient hematologic effects observed in the exposed residents were associated with the incident of leakage of mixed fire-extinguisher gases and were most likely caused by a small amount of pyrolytic products, probably phosgene. Nine months after the exposure, we found a significant improvement in the abnormalities without any specific treatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1289\/ehp.9197","type":"journal-article","created":{"date-parts":[[2006,8,18]],"date-time":"2006-08-18T08:14:06Z","timestamp":1155888846000},"page":"1713-1717","source":"Crossref","is-referenced-by-count":5,"title":["Grand Rounds: Outbreak of Hematologic Abnormalities in a Community of People Exposed to Leakage of Fire Extinguisher Gas"],"prefix":"10.1021","volume":"114","author":[{"given":"Shih-Hsiang","family":"Lo","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Zhongxing Branch of Taipei City Hospital, Taipei, Taiwan"},{"name":"Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang-Chuan","family":"Chan","sequence":"additional","affiliation":[{"name":"Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei-Chin","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Zhongxing Branch of Taipei City Hospital, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jung-Der","family":"Wang","sequence":"additional","affiliation":[{"name":"Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, Taiwan"},{"name":"Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan"},{"name":"Department of Environmental and Occupational Medicine, National Taiwan University Hospital, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"316","published-online":{"date-parts":[[2006,8,17]]},"reference":[{"key":"2026080522020624400_micit1","author":"Bloom"},{"key":"2026080522020624400_micit2","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1097\/00043764-200102000-00008","article-title":"Phosgene exposure: mechanisms of injury and treatment strategies","volume":"43","author":"Borak","year":"2001","journal-title":"Occup Environ Med"},{"key":"2026080522020624400_micit3","first-page":"51","article-title":"Phosgene inhalation: a case report","volume":"78","author":"Bradley","year":"1982","journal-title":"Tex Med"},{"key":"2026080522020624400_micit4","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1378\/chest.88.3.376","article-title":"Reactive airways dysfunction syndrome (RADS). Persistent asthma syndrome after high level irritant exposures","volume":"8","author":"Brooks","year":"1985","journal-title":"Chest"},{"key":"2026080522020624400_micit5","author":"Brugnara"},{"key":"2026080522020624400_micit6","author":"Bryan"},{"key":"2026080522020624400_micit7","doi-asserted-by":"crossref","first-page":"1192","DOI":"10.1034\/j.1399-3003.1999.13e41.x","article-title":"Reactive airways dysfunction syndrome following exposure to a fluorocarbon","volume":"13","author":"De La Hoz","year":"1999","journal-title":"Eur Respir J"},{"key":"2026080522020624400_micit8","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1097\/00043764-197803000-00007","article-title":"Medical phosgene problems and their possible solution","volume":"20","author":"Diller","year":"1978","journal-title":"J Occup Med"},{"key":"2026080522020624400_micit9","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1177\/074823378500100202","article-title":"Pathogenesis of phosgene poisoning","volume":"1","author":"Diller","year":"1985","journal-title":"Toxicol Ind Health"},{"key":"2026080522020624400_micit10","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1093\/occmed\/32.1.37","article-title":"The use of Halon 1301 for firefighting in confined spaces","volume":"32","author":"Harrison","year":"1982","journal-title":"J Soc Occup Med"},{"key":"2026080522020624400_micit11","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1080\/00028896909343173","article-title":"The inhalation toxicity of pyrolysis products of bromochloromethane (CF2BrCl) and bromotrifluoromethane (CF3Br)","volume":"30","author":"Haun","year":"1969","journal-title":"Am Ind Hyg Assoc J"},{"key":"2026080522020624400_micit12","first-page":"722","article-title":"Health effects of Halon 1301 exposure","volume":"34","author":"Holness","year":"1992","journal-title":"J Occup Med"},{"key":"2026080522020624400_micit13","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1002\/ajim.4700210212","article-title":"A study of the cardiac effects of bromochlorodifluoromethane (Halon 1211) exposure during exercise","volume":"21","author":"Kaufman","year":"1992","journal-title":"Am J Ind Med"},{"key":"2026080522020624400_micit14","author":"Lanzafame"},{"key":"2026080522020624400_micit15","author":"Louvar"},{"key":"2026080522020624400_micit16","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1080\/15298667991430118","article-title":"Cardiac arrhythmias and blood levels associated with inhalation of Halon 1301","volume":"40","author":"Mullin","year":"1979","journal-title":"Am Ind Hyg Assoc J"},{"key":"2026080522020624400_micit17","author":"Norton"},{"key":"2026080522020624400_micit18","author":"Rothman"},{"key":"2026080522020624400_micit19","doi-asserted-by":"crossref","first-page":"906","DOI":"10.1006\/bbrc.1996.1448","article-title":"Changes in absorbance at 413 nm in plasma from three rodent species exposed to phosgene","volume":"226","author":"Sciuto","year":"1996","journal-title":"Biochem Biophys Res Commun"},{"key":"2026080522020624400_micit20","author":"University of Michigan"},{"key":"2026080522020624400_micit21","author":"Wang"},{"key":"2026080522020624400_micit22","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1177\/074823378500100209","article-title":"Phosgene a practitioner\u2019s viewpoint","volume":"1","author":"Wells","year":"1985","journal-title":"Toxicol Ind Health"},{"key":"2026080522020624400_micit23","author":"WHO"}],"container-title":["Environmental Health Perspectives"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/pubs.acs.org\/evhpaz\/article-pdf\/114\/11\/1713\/66425077\/ehp.9197.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/pubs.acs.org\/evhpaz\/article-pdf\/114\/11\/1713\/66425077\/ehp.9197.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T13:52:01Z","timestamp":1786629121000},"score":1,"resource":{"primary":{"URL":"https:\/\/pubs.acs.org\/evhpaz\/article-lookup\/doi\/10.1289\/ehp.9197"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2006,8,17]]},"references-count":23,"aliases":["10.1289\/ehp.9179"],"journal-issue":{"issue":"11","published-online":{"date-parts":[[2006,8,17]]},"published-print":{"date-parts":[[2006,11,1]]}},"URL":"https:\/\/doi.org\/10.1289\/ehp.9197","relation":{},"ISSN":["0091-6765","1552-9924"],"issn-type":[{"value":"0091-6765","type":"print"},{"value":"1552-9924","type":"electronic"}],"subject":[],"published":{"date-parts":[[2006,8,17]]}}}