Acute radiation disease (ARD)

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Acute radiation disease(ARD)

• Prof. G.S. Moroz, MD
• Department of Oncology Radiology,
• Ternopil State Medical University

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Chernobyl

• The Chernobyl accident happened at 1 oclock 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 (?-irradiation of
  whole body and ß-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 during
• the first minutes or hours and manifest
• itself 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 become
• normalized 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