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Acute radiation disease(ARD)

Prof. G.S. Moroz, MDDepartment of Oncology & Radiology,

Ternopil State Medical University

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Chernobyl The Chernobyl accident happened at 1

o’clock 24 minutes a.m. on April, 26th,1986, was the biggest global

radiation catastrophe in the World One hundred million Ci radioactive

isotopes were threw out into atmosphere

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Victims Six hundred Chernobyl accident victims

exposured irradiation in large doses (γ-irradiation of whole body and β-irradiation vast surfaces of the body)

In 134 persons were diagnosed ARD, 28 of them have died in the first 4 months after exposure and 15 more during later period

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Acute radiation disease (ARD) after Whole-Body Relatively Uniform Irradiation Manifestation of the ARD depends primarily on the

following factors: The type of irradiation (whole body or local) External or from incorporated radioactive isotopes The time factor (single, repeated, prolonged, or

chronic irradiation) The space factor (uniform or non-uniform The irradiated volume And localization of the irradiated portion

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Continued

Three periods are distinguished in the course of the ARD:

The formation period The recovery period The period of outcomes and Consequences (effects)

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Continued The formation period of the ARD can be

divided into four phases: The phase of the primary acute response The phase of apparent clinical well-being (the latent period) The phase of the height of the disease The phase of early recovery

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Continued

The ARD is also distinguished according to the severity of the damage

(determined by the absorbed dose)

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Continued

A developed complex of symptoms (syndromes) of the ARD appears at doses exceeding one Gray (1Gy)

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Continued

In the dose range of 1 – 6 Gy, three degrees of severity of the ARD are distinguished

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Continued ARD of the 1st (light) degree (1 – 2

Gy) ARD of the 2nd (moderate) degree

(2-4 Gy) ARD of the 3rd (severe) degree (4 –

6 Gy)

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Continued

At doses exceeding six Grays, the ARD is estimated as an extremely severe – the 4th Degree

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Continued

Singling out: Intestinal form Cerebral form and their transient Toxic form

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Continued

At doses of 6 – 10 Gy a transient form of the ARD develops

special treatment can ensure survival

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Continued

At doses of 10 – 20 Gy – a typical form of intestinal damage appears

A lethal outcome in 8 – 16 days

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Continued

At doses of 20 -80 Gy – toxemic injury develops (vascular form of damage)

Death – on the fourth to seventh day from meningitis

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Continued

At doses exceeding 80 Gy – a cerebral form of damage appears

Death in one to three days

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Prognostic features

The development of a state of shock with a drop in blood pressure, a brief loss of consciousness, a subfebrile temperature, and diarrhea are unfavourable features in a prognostic respect

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Phase of Primary Acute response

The primary response appears duringthe first minutes or hours and manifestitself in all cases of irradiation at doses

exceeding two Grays. This phase lasts from one to three

days

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Dyspeptic syndrome

Nausea and vomiting appear That increase after the taking of food The appetite is lost Sometimes dryness and bitterness is

felt in the mouth

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Complaints continued

Sometimes patients have a feeling of heaviness in their head, headache, general asthenia and drowsiness

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Objective signs

On portions of the skin exposed to doses of 6 – 10 Gy, transient hyperemia of the type of sunburn appears

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Objective signs continued Appear, namely, asymmetry of the

tendon reflexes, an increase in dermographia, and lability of the skin vasomotor responses

Features of nerve and reflex disturbances

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Changes indices of blood

During the first day after exposure, neutrophilic leucocytosis with a shift to the left, as well as absolute and relative lymphopenia are observed in the peripheral blood

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Biochemical changes

At doses above 4 Gy we can note: An increase in the sugar and bilirubin level Drop in the content of chlorides and Amino-aciduria (as a result of cells

destroyed) Hyperamylasemia (as a result of the salivary

glands damage)

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Phase of Apparent Clinical Well-Being The symptoms of the primary response

vanish in 2 – 4 days Patients feel better or even normal The disease enters into second phase

(the latent phase)

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The duration of the latent phase

It depends on the severity of damage It fluctuates from 14 to 32 days In very severe forms of damage (at

doses exceeding 10 Gy), this phase is absent in general

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Changes indices of blood

Analysis of the blood shows: Lymphopenia Throbocytopenia A drop in the number of neutrophils

and reticulocytes

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Changes in the bone marrow Aplasia is clearly expressed (in the very

first days) Features of regeneration appear with

second or third week The suppression of spermatogenesis and Skipping of a menstrual cycle may be

observed

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Phase of Pronounced Clinical Manifestations

In from two to four weeks the state of patients again sharply worsens:

Asthenia increases The temperature rises The erythrocyte sedimentation rate

(ESR) grows

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Hemorrhagic syndrome

Hemorrhages appear in: Skin (petechiae) Mucous membrane Gastro-intestinal tract Intracranial Cardiac intrapulmonary

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Changes indices of blood

Lymphopenia with relative lymphocytosis

All the other elements of the white blood are present in a very few cells or disappear completely

Anemia appears and begins to progress

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By the end of the phase

Regeneration is noted in The bone marrow Lymph nodes

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Continued Are observed: Hypoproteinemia Hypoalbuminemia Reduction in the amount of

chlorides in the hemopoietic system

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The third phase

Lasts from one to three weeks And then in cases with a favourable

outcome it passes over to The fourth phase - recovery

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Phase of Early Recovery

The beginning of this phase is characterized by normalization of

The temperature Improvement of state The appearance of an appetite The restoration of sleeping

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Continued The hemorrhages stop the dyspeptic phenomena disappear The mass of patients grows rapidly Gradual recovery of the blood indices

occurs

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But

In the peripheral blood appear: Reticulocytes Juvenile leucocytes (up to myeloblasts) Juvenile forms of thrombocytes Anemia increases and reaches its peak

by fifth or sixth week

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Next

The number of erythrocytes begins to grow

In two or three months reaches its initial level

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The biochemical indices

Of the blood and urine becomenormalized during this period

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The recovery phase

Lasts from 2 to 2,5 months Alopecia continues (hair growth

renews only by the fourth month) The ability of reproduction normalizes

only in four to six months

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Treatment of the ARD

Replacement of the loss in critical systems of cell renewal – the main task of pathogenic therapy

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Continued Bone marrow transplantation (as usually

is used at doses more than 10 – 12 Gy) Peripheral blood transfusion (prefer to

the cellular components of blood) The transfusion of liquids, salt

solutions, glucose, etc. compensating the loss of electrolytes and water

Antibiotics of the wide spectrum

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Functional therapy

The measures taken in substitution therapy can also be related to the functional (symptomatic) treatment:

Supportive care (nursing, nutritional support, etc.)

Psychosocial aspects