Section 325.77109d. Additional examinations and referrals.

d. (a) If the results of the complete blood count required for the initial and periodic examinations indicate that any of the following abnormal conditions exist, then the employer shall ensure that the blood count is repeated within 2 weeks:

(i)    The hemoglobin level or the hematocrit falls below the normal limit, that is, outside the 95% confidence interval (C.I.), as determined by the laboratory for the particular geographic area or these indices show a persistent downward trend from the individual's preexposure norms and these findings cannot be explained by other medical reasons.

(ii)    The thrombocyte (platelet) count varies more than 20% below the employee's most recent values or falls outside the normal limit (95% C.I.) as determined by the laboratory.

(iii)   The leukocyte count is below 4,000 per mm3 or there is an abnormal differential count.

(b)    If the abnormality persists, then the employer shall ensure that the examining physician   refers  an  employee   to  a  hematologist  or   an  internal  medicine   physician

(internist) for further evaluation, unless the physician has good reason to believe the referral is unnecessary. (See Appendix C for examples of conditions where a referral may be unnecessary.)

(c)   An employer shall provide the hematologist or internist with all the information required under R 325.77109e and the medical record required to be maintained according to R 325.77111a.

(d)  An employer shall ensure that the hematologist's or internist's evaluation includes a determination as to the need for additional tests, and an employer shall ensure that the needed tests are provided.

History: 2014 AACS.