Effect of Automotive Oils on Blood Indices and Liver Function of Adults and Children Automobile-Repairing Mechanics in Kabul City

doi:10.21203/rs.3.rs-2195667/v1

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Effect of Automotive Oils on Blood Indices and Liver Function of Adults and Children Automobile-Repairing Mechanics in Kabul City

https://doi.org/10.21203/rs.3.rs-2195667/v1

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Background: Chronic exposure to petroleum products’ ingredients, such as basic chemicals, additives, and pollutants, can affect the hematological system and liver. Automobile repair shop mechanics are a group of people who are constantly exposed to petroleum products. In Afghanistan, children labor alongside adults in automobile repair shops. Therefore, we aimed to find the effect of these products on the hematological system and liver function of children and adults at automobile repair shops in Kabul city of Afghanistan.

Methods: In this cross-sectional study, individuals who worked in automobile-repair shops in Kabul, Afghanistan, were compared to healthy control groups in two age categories: adults (≥18 years old), and children (<18 years old). Hematological tests for blood indices and biochemical studies for liver function were done. Based on the normal or abnormal distribution of data, the central tendencies of exposed and control groups were compared using the Student's t-test and Mann-Whitney U test respectively.

Results: Only MCV was significantly different between adults exposed and control groups in terms of blood indices. MCH, MCV, MID, MPV, PLC, PDW, and Neut/Lym ratios differed significantly between exposed and control groups in children. Albumin and globulin levels in adults, and albumin and AST levels in children were significantly different between the exposed and control groups in terms of liver function tests.

Conclusion: Children are more affected by occupational exposure to petroleum products than adults.

Occupational exposure

automotive repairing workshop

automobile oil

child worker

liver function

blood indices.

Automobile workshop workers are a class of laborers who are prone to petroleum product toxicity due to their daily tasks such as motor vehicle assembly, spray painting, burning of petrol, welding brazing, and repairing radiators (Varghese, 2006). Through their skin, mouth, and breathing, these workers are exposed to a number of substances, including gasoline, benzene, lead, asbestos, exhaust fumes, and many more (Mathew Philip, 2014).

Gasoline is a complex manufactured mixture produced from petroleum in the refining process. Exposure to motor gasoline is most often obtained through inhaling its vapor at gasoline pump stations, black-market gasoline vendors, and automobile repairing workshops. Occupational exposure to petroleum vapors has been shown to have harmful effects on the immune system, respiratory system, neurological system, heart, skin, kidneys, and liver, leading to a range of disorders (Awasthi, Joshi, Swarup, Mandal, & Awasthi, 2016). Liquid gasoline is a complex mixture including at least 150 different types of hydrocarbons as the basic ingredient, as well as antioxidants, scavenging agents, lubricants, and other additions. The vapor phase contains a higher fraction of tiny chain and low carbon-numbered compounds than larger and heavier molecules. In the vapor phase of gasoline, the more hazardous aromatic components are depleted to roughly 2% (Page & Mehlman, 1989). Numerous researches have reported on the mutagenic and harmful consequences of aromatic compounds of gasoline such as benzene, toluene, and xylenes (Dean, 1978). Benzene is classed as a Group A, human carcinogen with a medium carcinogenic hazard, according to the Environmental Protection Agency. In Europe, the acceptable benzene exposure levels for long-term (8-hour) and short-term (5-hour) exposure are 1 ppm (part per million) (3.25 mg/m3) and 5 ppm, respectively (Lanyon, Marrazza, Tothill, & Mascini, 2005). The OECD (Organization for Economic Co-operation and Development) countries have set a maximum limit of 5% benzene in gasoline, while the US has set a maximum limit of 1%, Japan and some Western European countries are considering a 3% restriction. In gasoline, lead was employed as an anti-knocking ingredient, but octane is gradually replacing it (Menkes & Fawcett, 1997).

Workers who work on automobiles are exposed to low levels of benzene. Full-shift exposure levels vary from 0.03–2.6 mg/m3, with high-level task-specific exposure levels ranging from 0.33 to15.28 mg/m3 (Alexander C. Capleton, 2005). The effects of high-level benzene exposure on the Central Nervous System are reversible. However, persistent low-level benzene exposure is usually irreversible and can harm the hematological system (Nordlinder & Ramnas, 1987).

Chronic exposure to benzene causes a progressive decline of hematopoietic function which may lead to the onset of various disorders such as aplastic anemia, myelodysplastic syndrome, and leukemia. Benzene's toxicity can be expressed by the production of ROS (reactive oxygen species) as a result of reactive metabolic intermediates, which can cause oxidative cell damage (Hegazy & Kamel, 2014). Its metabolites, phenol, and hydroquinone are most likely responsible for its carcinogenicity. In the bone marrow, hydroquinone is oxidized to 1,4-benzoquinone, an extremely poisonous chemical (Smith, et al., 2000).

The liver is the primary organ for drug and hazardous chemical metabolism. Organic solvents primarily target the liver, and occupational exposure to them may cause hepatotoxicity. Age, nutritional status, genetic factors, species variations, medication interactions, and alcohol consumption and interaction are all potential contributors to this toxicity (Malaguarnera, et al., 2012).

Employees in automobile-workshops are subjected to long working hours, poor remuneration, and insufficient social protection, as well as a high risk of disease and mortality, according to studies.

Occupational exposure to benzene and petroleum products has been studied in various other countries with controversial results. Since various factors such as genetic differences, lifestyle, workspace, addiction, and narcotic use may interfere, we studied occupational exposure to benzene and petroleum products for the first time in Kabul, Afghanistan, by evaluating blood indices and liver function of automobile mechanics of varying ages. Kabul residents are the only population studied. It's also the first study of its kind to look at the impact of automobile oil on blood indices and liver function at different ages, including before and after puberty among automobile-repairing mechanics.

Sample and study design

This cross-sectional study was conducted from April 15, 2018, to August 20,2018, which covered two male age groups. These grouping include the adults group (AG) ≥ 18 years old, and the children group (CG) < 18 years old. The adult group consisted of 53 people, 24 of whom were automobile-repair mechanics from three different auto-repair marketplaces in Kabul, Afghanistan (age, mean SD = 26.7 ± 9.4), and 29 of whom were controls who were not occupationally exposed to petroleum products (age, mean SD = 29 ± 8.5). Similarly, the children group had 49 individuals separated into two groups: exposed and controls, each with 25 (age, mean SD = 13.7 ± 1.6) and 24 (age, mean SD = 12 ± 2.9) children respectively. All consecutive people who provided informed consent were recruited for the study using a simple convenience sampling procedure. The questionnaire was created to gather data on the individuals' age, sex, working period, health history, education level, drugs and alcohol usage, and precautionary manner.

Inclusion criteria

Workers who were directly exposed to petroleum products while working as machine mechanics, had at least a year's worth of continuous full-day experience working in car repair shops, did not have genetic abnormalities, and were willingly agreed to participate in the research were included in this study.

Exclusion criteria

Workers who had not been directly exposed to petroleum products while working as mechanics, had less than one year of continuous experience as mechanics, more than one year of non-continuous experience, or had genetic abnormalities were excluded from the study.

Specimen collection

Hematologic tests

Approximately 3ml venous blood was collected and placed into an EDTA (Ethylenediaminetetraacetic acid) vacutainer for hematological profile analysis, which was transported to the laboratory within 1–2 hours by field ice-box. Hematological tests were carried out with the use of an automated hematological analyzer (Medionic p3000- CBC counter, Sweden). Hematological parameters include white blood cells (WBC), lymphocytes% (Lym%), mid-range cells% (MID%), granulocytes% (GRA%), hemoglobin (Hb), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), red blood cells (RBC), mean corpuscular volume (MCV), hematocrit (HCT), red cell distribution width (RDW), platelets (PLT), mean platelet volume (MPV), platelet distribution width (PDW), plateletcrit (PCT), Neutrophil/Lym ration, and PLT/Lym ratio.

Biochemical tests

About 2mls venous blood was collected and transferred into a gel tube for biochemical analysis to obtain serum. Samples were carried by field ice-box to the laboratory within 1–2 hours and immediately centrifuged in 1500 g for 10 minutes. The serum was transferred to Eppendorf tubes and refrigerated for use in subsequent procedures. For the liver function test, the amount of total protein (TP), albumin, alanine transaminase (ALT), aspartate transaminase (AST), and gamma-glutamyl transferase (GGT) in serum was determined, and the optical density was obtained using UV visible spectrophotometer (Shimadzo, Japan). The kits for liver function tests were GGT from DiaSys and the rest were from Randox Laboratories Ltd.

Data analysis

Microsoft Excel was used to enter the data. Before selecting tests for comparing central tendencies between exposed and control groups, the Prism-GraphPad-5 software used to examine the normal distribution of data within each group using the D'Agostino & Pearson omnibus K2 normality test, which is recommended by the official website of GraphPad Prism (GraphPad, 2018). If there was a significant difference between the data distribution and the Gaussian distribution in any of the comparison groups, the non-parametric Mann-Whitney U test was used, the Median between the two comparison groups was compared, and the result was displayed as the median (IQR). If both comparison groups obtained normal distribution data, the Homogeneity of variances was tested using Parametric Levene’s test by statistical Package for Social Science (SPSS) version 21. If there was no homogeneity of variance between the two comparison groups, the non-parametric test of Mann-Whitney U was applied, if there were homogeneous variances, the parametric test of independent t-test using SPSS software was applied and the mean of the groups compared, and the result presented in mean ± SD. P-values less than 0.05 are considered significant differences.

Ethical Consideration

The study was carried out after receiving approval from the research and ethics committee of the Faculty of Pharmacy with letter number 4844, the research committee of Kabul University with letter number 332, and the research committee of the Ministry of Higher Education-Afghanistan with letter number 2241. Written informed consent from voluntarily participants was obtained after explaining the purpose of the study. The Declaration of Helsinki was considered for conducting this study.

In this study, two different age groups were included. The adults group consisted of 53 people, 24 of whom were automobile-repair mechanics from three different auto-repair marketplaces in Kabul, Afghanistan (age, mean ± SD = 26.7 ± 9.4), and 29 of whom were controls who were not occupationally exposed to petroleum products (age, mean ± SD = 29 ± 8.5). Similarly, the children group had 49 individuals separated into two groups: exposed and controls, each with 25 (age, mean ± SD = 13.7 ± 1.6) and 24 (age, mean ± SD = 12 ± 2.9) younger teenagers respectively. All members of the exposed groups were machine mechanics. 66.6% (16) of AG had more than 10 years of work experience as a mechanic, 16.6% had between 5 to 10 years and 16.6% had less than 5 years but more than 1 year of experience as a machine mechanic. One member had high blood pressure and one had prostatitis in AG, while all exposed members were healthy in the children group. Almost all AG members were working more than six hours per day, six days a week, while in the exposed children group average working hours per day was 4–6, six days a week.

In the AG group, the average job experience as a machine mechanic was 14.1 years, whereas it was less than 5 years in the children group. In the adults group, 58.3% (14 people) were illiterate, 37% (9 individuals) had literacy less than school graduation, and only 4.1% (1 individual) was graduated from school, but in the children group, 32% (8 individuals) were illiterate and 68% (17 individuals) had literacy less than school graduation. All of the children in the group had fewer than 5 years of garage experience. Mechanics did not use personal protective equipment. Only they washed their hands with soap or detergents before the meal. They do not get shower every day.

Statistically no significant differences were observed between the central tendencies of adults exposed and control groups in the case of WBC, lymphocytes, MID cells, granulocytes, hemoglobin, MCH, MCHC, RBC, HCT, RDW, platelets, MPV, PDW, PCT, Neut/Lym ratio, and PLT/Lym ratio. MCV was the only hematological parameter that had a significantly (P = 0.034) lower median in the exposed group (80.5 (78.6–82.6)) compared to the control group (82.1 (80.2–86.4)) (Table 1).

In contrast, several parameters in children had significant differences between exposed and control groups. WBC, GRA%, MCHC, and Neut/Lym ratio were significantly lower in the exposed group than the control group, while Lym, MID, MCV, HCT, MPV, PDW, and PCT were significantly higher in the exposed group than the control group. Parameters such as Hb, MCH, RCB, RDW, PLT, and PLT/Lym were not significantly different between the exposed and control groups (Table 1).

Total protein was not statistically different between adult exposed and control groups, while globulins were significantly higher, albumin and A/G ration were significantly lower in the adults exposed group than the control group. ALT, AST, ALP, and GGT were not significantly different (Table 2).

Also, in children group, only albumin and AST were significantly lower in the exposed group compared to the control group. Other liver parameters showed no significantly different between exposed and control groups (Table 2).

Table 1

CBC Picture of the Study Groups Using Independent Samples t-Test and Mann-Whitney U –Test.
A) Adults, n = 53
Parameter	exposed	Control	P-value
Parameter	mean ± SD/median (IQR)	mean ± SD/median (IQR)	P-value
WBC	6.5 (5.9-7.0)	6.9 (6.0-7.3)	0.5082
Lymphocytes	34.0 (± 7.1)	32.9 (± 5.9)	0.530
MID	7.2 (± 0.8)	7.1 (± 0.8)	0.530
GRA	58.7 (± 7.4)	59.9 (± 6.1)	0.529
Hemoglobin	15.8 (15.5–16.3)	15.9 (15.4–16.2)	0.753
MCH	28.5 (28.0-29.3)	28.8 (28.0-30.2)	0.252
MCHC	35.2 (34.8–35.6)	35.0 (34.2–35.5)	0.111
RBCs	5.5 (5.3–5.9)	5.4 (5.1–5.7)	0.271
MCV	80.5 (78.6–82.6)	82.1 (80.2–86.4)	0.034
HCT	44.8 (43.5–46.1)	45.5 (44.0-47.2)	0.421
RDW	10.8 (10.6–11.0)	11.1 (10.6–11.5)	0.093
Platelets	225.0 (196.8–240.0)	232.0 (188.0-269.5)	0.469
MPV	7.4 (7.2–7.8)	7.8 (7.2–8.4)	0.162
PDW	10.9 (10.6–11.2)	11.3 10.6–12.2)	0.185
PCT	0.16 (± 0.01)	0.17 (± 0.03)	0.192
Neut/Lym ratio	1.9 (± 0.6)	1.9 (± 0.5)	0.708
PLT/Lym ratio	104.3 (± 28.2)	108.7 (31.6)	0.603
B) Children, n = 49
Parameters	Exposed	control	P-value
Parameters	mean ± SD/median (IQR)	mean ± SD/median (IQR)	P-value
WBC	6.6 (± 1.8)	7.6 (± 1.5)	0.062
Lymphocytes	37.9 (± 7.4)	30.2 (± 8.4)	0.001
MID	8.0 (6.4–9.3)	6.5 (5.3–7.1)	0.001
Granulocytes	54.0 (± 7.9)	63.3 (± 9.6)	0.001
Hemoglobin	14.8 (13.2–16.0)	13.8 (13.2–14.3)	0.076
MCH	27.4 (26.7–27.4)	27.0 (25.7–27.9)	0.183
MCHC	34.6 (33.8–35.0)	35.1 (34.3–35.9)	0.0284
RBC	5.4 (4.9–5.8)	5.1 (4.7–5.4)	0.258
MCV	79.6 (77.9–81.1)	76.9 (73.8–78.3)	0.001
HCT	43.2 (38.7–46.7)	39.5 (37.1–40.5)	0.013
RDW	11.0 (10.9–11.5)	11.0 (10.6–11.4)	0.427
Platelets	257 (± 62.7)	262.2 (± 49.5)	0.772
MPV	7.8 (7.3–8.2)	6.6 (6.1–7.1)	< 0.0001
PDW	11.1 (10.5–11.9)	9.9 (9.5–10.4)	< 0.0001
PCT	0.17 (± 0.03)	0.19 (± 0.04)	0.044
Neu/Lym ratio	1.6 (1.1–1.9)	2.2 (1.8–3.1)	0.0006
PLT/Lym ratio	110.7 (± 36.5)	125.9 (± 37.8)	0.159

Table 2

Liver function test Picture of the Study Groups Using Independent Samples t-Test and Mann-Whitney U –Test.
A) Adults, n = 53
Parameter	exposeds	Control	P-value
Parameter	mean ± SD/median (IQR)	mean ± SD/median (IQR)	P-value
Total Protein	7.0 (± 0.6)	7.1 (± 0.6)	0.409
Serum Albumin	4.2 (3.7–4.7)	4.8 (4.5–5.1)	0.003
Serum globulin	2.7 (2.4–3.1)	2.3 (1.9–2.8)	0.025
A/G ratio	1.5 (1.3–1.8)	2.0 (1.6–2.4)	0.0008
ALT	21.0 (14.5–34.5)	15.4 (11.7–21.0)	0.092
AST	13.4 (10.7–16.3)	14.0 (12.8–16.6)	0.435
GGT	8.7 (7.5–19.9)	10.7 (7.5–19.9)	0.225
B) Children, n = 49
Parameter	exposed	Control	P-value
Parameter	mean ± SD/median (IQR)	mean ± SD/median (IQR)	P-value
Total Protein	6.9 (6.4–7.5)	6.9 (6.2–7.5)	0.718
Serum Albumin	4.1 (3.7–4.2)	4.3 (4.0-4.6)	0.013
Serum globulin	2.8 (2.3–3.6)	2.5 (1.9–3.2)	0.231
A/G ratio	1.4 (1.0-1.7)	1.7 (1.3–2.2)	0.093
ALT	15.7 (± 5.6)	15.6 (± 5.4)	0.955
AST	16.9 (14.5–19.5)	20.4 (16.3–23.5)	0.027
GGT	10.5 (8.1–14.3)	10.4 (8.1–13.3)	0.836

This study aimed to assess the effect of automobile machine oil products on blood indices and liver function of automobile-repairing mechanics with a focus on the age differences, ≥ 18 years old and < 18 years of old in Kabul city of Afghanistan. Child labor is a certain issue in Afghanistan. More than 1 million Afghan children are engaged in labor (Aljazeera, 2022). Children even less than 10 years of age are working in automobile-repairing workshops without any occupational safety. Our study shows that automobile machine oil products have more adverse effects on the blood indices of children than adults.

In contrast to findings from other nations including Nigeria, Ghana, and India, only MCV was significantly lower in the adults exposed group compared to the control group in our study; the rest of the blood indices were not statistically different. According to their findings, there are a number of hematological indicators that significantly differ between the control and exposed groups. In their research, the exposed group's hematological parameters including HCT, Hb, WBC, RBC, and PLT were lower than those of the control group (Adu, et al., 2018; Aleemuddin, Babu, Manjunath, & Quadri, 2015; Okoro, Ani, & Akpogomeh, 2006; Ukaejiofo, Nubila, & Ike, 2006). At the same time, another study conducted in Nigeria revealed that PCV, Hb, and neutrophil significantly increased in the exposed group compared to the control group (Omorowa, et al., 2015).

Exposure to low levels of benzene has controversial results. Studies show that exposure to low benzene vapors concentration even < 1ppm leads to a decrease of leukocytes, especially effect on progenitor cells (Lan, et al., 2004) and another study reported that occupational exposure to benzene concentration less than 5ppm causes a decrease of all types of blood cells (Qu, et al., 2002). However, some other studies reported no decrease in blood cells in case of occupational exposure to the low concentration of benzene (Tsai, et al., 2004; James, Ireland, Easterday, Nair, & Braun, 1997; James, et al., 1991).

In the case of children in our study, most of the blood indices are significantly different between exposed and control groups. No study on automobile-repairing workshop child workers has been previously reported.

In our study, less effect of occupational exposure to automobile-machine oil products on blood indices of adults might be attributable to a variety of variables. We discovered that practically all mechanics worked outside, rather than in garages or other enclosed spaces in Kabul city. Close doors and inadequate ventilation raise the benzene levels within the garage (Nordlinder & Ramnas, 1987). Even inside autos, benzene levels are greater than outdoors. Most children's leukemia is thought to be caused by greater benzene concentrations inside autos (Menkes & Fawcett, 1997). Temperature, on the other hand, has a direct effect on gasoline vapor concentration. As a result, gasoline vapors are higher in the summer than in the winter (Page & Mehlman, 1989). The weather in Afghanistan is not warm for around 6 months of the year. As a result, fewer gasoline vapors may be produced. In this sense, studies in warmer countries such as Nigeria, India, Ghana, and Iraq show more differences in blood indices among exposed and control groups

In our study through a questionnaire, we discovered that the majority of automotive-repairing workers consumed more fruits and vegetables, and less meat. They were not taking booze, narcotics, or cigarettes; instead, three adult mechanics were occasionally amusingly smoking marijuana. This might reduce the negative effects of benzene products since studies have indicated that benzene levels are greater in the blood of smokers in automotive-repairing workshops (Kamal & Rashid, 2014), and hematological changes are significantly associated with smoking habit in fuel-filling station personnel (Sahb, 2011).

In recent years, there has been increased interest in predicting the prognosis of diseases with simple blood tests associated with systemic inflammation (Lee, Kim, Na, Youn, & Shin, 2018). In our study, these metrics (Neut/Lym and PLT/Lym ratios) did not change significantly between adults exposed and control groups, however, the Neut/Lym ratio was much lower in the children exposed group, indicating that workers do not have symptoms of the systemic inflammation or malignancy. Lymphocytes are much greater in the adults-exposed group than in the control group; however, whether or not this is related to Micronucleus lymphocytes has not been explored in our study. Previous research has found that micronucleus lymphocyte levels are higher in people who are occupationally exposing benzene than the control people (Zhang, 1996). An increase in micronucleus lymphocytes is a predictor of cancer risk which shows chromosomal damage (Bonassi, et al., 2007).

The adults exposed group have a significantly lower albumin and albumin-globulin ratio and higher globulin level than the control group. Other liver parameters are not significantly different, however, ALT, ALP, and GGT are non-significantly higher in the exposed groups than in the control group. Albumin is a negative-phase reactant protein that decreases due to infection, and globulin is increased. Albumin levels also decrease due to insufficient blood supply to the liver, and in an early stage of liver cirrhosis globulin level is increased which compensates for total protein while albumin level is decreased (Bioshop, Fody, & Shoeff, 2010). Khan et al. found that ALT is significantly increased (Khan, Inam, Idrees, Gul, & Haji, 2010), while other study shows decreased levels of ALT, AST, and ALP in exposed groups (Omorowa, et al., 2015). Our studies in the case of adults show similarities with Hegazy & Kamel while it is opposite to the Pool & Osorio findings (Hegazy & Kamel, 2014; Pool & Osorio, 2001). In the case of children, we also found only albumin and AST are significantly lower in the exposed group than in the control group.

There is no official data about the composition of the fuel imported into Afghanistan, whether lead is added as an anti-knocking agent or not. By the way, Ibeh et al found higher blood lead levels in automobile-repairing mechanics than in the control group. MCV, MCH, and MCHC were negatively correlated with blood lead level (Ibeh et al., 2016). Chronic exposure to lead at levels < 50 µg/dL causes a decrease of MCV and HCT in the lead-exposed group in comparison to the control group, while RBC count and hemoglobin do not alter. Lead may inhibit ALAD (Aminolevulinic Acid Dehydrogenase) enzyme but with up to 80–90% inhibition of ALAD enzyme, hemoglobin concentration is not affected. MPV and MCHC is increased, proportions of different types of leukocytes are altered but the number of WBC and PLT are not changed (Chwalba, et al., 2018).Automobile-repairing mechanics also expose to spent oils which contains heavy metals and polycyclic aromatic hydrocarbons (Omorowa, et al., 2015).

This is the first study on the population of Afghan mechanics, and the first study in its kind on children labor in automobile-repairing workshops. The finding of this study has to be seen in the light of some limitations. The sample size is small, and the sampling method was not random.

Automobile oil comes in a variety of compounds, some of which may be detrimental to the body, such as benzene. Occupational exposure to these products has been linked to organ toxicity in several studies. Our research found that children's hematopoietic systems are more affected by occupational exposure to automobile oils than adults'. The majority of hematological parameters differed significantly between the child-exposed and control groups. In both age groups, liver function tests were nearly identical.

More research is needed to identify if the significant variations in hematological parameters observed in the child-exposed group compared to the control group are attributable to the effect of occupational exposure to machine oils, or are due to child labor and work pressure. Furthermore, these youngsters must be followed up on in order to assess the long-term impacts of occupational exposure to machine oils. A comparative study among cold and warm cities of Afghanistan might provide a better understanding of the relationship between weather and machine oil impacts.

A/G

Albumin/Globulin ratio

Adults Group

ALAD

Aminolevulinic Acid Dehydrogenase

ALT

Alanine Transaminase

AST

Aspartate Transaminase

CBC

Complete Blood Count

Children Group

EDTA

Ethylenediaminetetraacetic acid

GGT

Gamma-Glutamyl Transferase

GRA

Granulocytes

Hemoglobin

HCT

Hematocrit

IQR

Interquartile Range

Lym

Lymphocytes

MCH

Mean Corpuscular Hemoglobin

MCHC

Mean Corpuscular Hemoglobin Concentration

MCV

Mean Corpuscular Volume

MID

Mid-range Cells

MPV

Mean Platelet Volume

Neut/Lym

Neutrophil/Lymphocyte ration

OEDC

Organization for Economic Co-operation and Development)

PCT

Plateletcrit

PDW

Platelet Distribution Width

PLT/Lym

Platelet/Lymphocyte ratio

PLT

Platelets

ppm

Parts Per Million

RBC

Red Blood Cell

RDW

Red cell Distribution Width

ROS

Reactive Oxygen Species

Standard Deviation

SPSS

Statistical Package for Social Science

Total Protein

WBC

White Blood Cells

-Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

-Conflicts of interest: The authors declare no conflict of interest.

-Availability of data and material: Data included in the article.

-Code availability (software application or custom code): not applicable
Authors’ contributions: All experimental designs, investigations, and analyses were carried out by N.N., and Z.A. The manuscript was written by N.N and Z.A. and critically reviewed by Z.I. All authors read and approved the final manuscript.

-Acknowledgement: Not applicable

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No competing interests reported.

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Effect of Automotive Oils on Blood Indices and Liver Function of Adults and Children Automobile-Repairing Mechanics in Kabul City

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