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Hematological changes in formaldehyde-exposed workers: A critical review and meta-analysis
Reza Pourbabaki1, Fatemeh Rahimian2, Mohammad Ebrahim Ghaffari3
1Department of Occupational Health Engineering, Sirjan School of Medical Sciences, Sirjan, Iran.
Toxicology and Industrial Health
|August 1, 2026
Summary
Formaldehyde exposure may alter blood cell counts, particularly white blood cells, T cytotoxic cells, and natural killer cells. However, current exposure assessments are inconsistent, limiting conclusions on dose-response relationships for formaldehyde hematotoxicity.
Area of Science:
- Toxicology
- Occupational Health
- Hematology
Background:
- Formaldehyde (FA) is a common chemical linked to cancer, raising concerns about its potential to cause blood disorders (hematotoxicity) and leukemia.
- Previous research has explored the health risks associated with FA exposure, necessitating a closer look at exposure assessment quality.
Purpose of the Study:
- To systematically review and assess the quality of exposure evaluations in studies on FA hematotoxicity.
- To determine the association between FA exposure and blood dyscrasias through meta-analysis.
Main Methods:
- Conducted a systematic review of 22 studies investigating FA hematotoxicity.
- Performed a meta-analysis on 10 studies with sufficient data on FA exposure and blood parameters.
Main Results:
- FA exposure was significantly associated with decreased white blood cells (SMD = -1.450) and increased T cytotoxic cells (SMD = 2.813) and natural killer cells (SMD = 1.911).
- No clear dose-response relationship was established due to limitations in exposure assessment methods across studies.
- Observed blood parameter changes might be linked to FA's irritant effects on the upper respiratory tract.
Conclusions:
- Inhaled FA does not appear to distribute to distal tissues.
- Future studies require comprehensive exposure evaluations using validated methods and biological monitoring to clarify the FA-hematotoxicity link.
- Further research is needed to accurately assess worker exposure to formaldehyde and its potential hematotoxic effects.
