1. 1 Acute radiation disease (ARD) Prof. G.S. Moroz, MD Department of Oncology & Radiology, Ternopil State Medical University

2. 2 Chernobyl The Chernobyl accident happened at 1 o’clock 24 minutes a.m. on April, 26 th,1986, was the biggest global radiation catastrophe in the World One hundred million Ci radioactive isotopes were threw out into atmosphere

3. 3 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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6. 6 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

7. 7 Continued Three periods are distinguished in the course of the ARD: The formation period The recovery period The period of outcomes and Consequences (effects)

8. 8 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

9. 9 Continued The ARD is also distinguished according to the severity of the damage (determined by the absorbed dose)

10. 10 Continued A developed complex of symptoms (syndromes) of the ARD appears at doses exceeding one Gray (1Gy)

11. 11 Continued In the dose range of 1 – 6 Gy, three degrees of severity of the ARD are distinguished

12. 12 Continued ARD of the 1 st (light) degree (1 – 2 Gy) ARD of the 2 nd (moderate) degree (2-4 Gy) ARD of the 3 rd (severe) degree (4 – 6 Gy)

13. 13 Continued At doses exceeding six Grays, the ARD is estimated as an extremely severe – the 4 th Degree

14. 14 Continued Singling out: Intestinal form Cerebral form and their transient Toxic form

15. 15 Continued At doses of 6 – 10 Gy a transient form of the ARD develops special treatment can ensure survival

16. 16 Continued At doses of 10 – 20 Gy – a typical form of intestinal damage appears A lethal outcome in 8 – 16 days

17. 17 Continued At doses of 20 -80 Gy – toxemic injury develops (vascular form of damage) Death – on the fourth to seventh day from meningitis

18. 18 Continued At doses exceeding 80 Gy – a cerebral form of damage appears Death in one to three days

19. 19 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

20. 20 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

21. 21 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

22. 22 Complaints continued Sometimes patients have a feeling of heaviness in their head, headache, general asthenia and drowsiness

23. 23 Objective signs On portions of the skin exposed to doses of 6 – 10 Gy, transient hyperemia of the type of sunburn appears

24. 24 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

25. 25 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

26. 26 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)

27. 27 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 )

28. 28 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

29. 29 Changes indices of blood Analysis of the blood shows: Lymphopenia Throbocytopenia A drop in the number of neutrophils and reticulocytes

30. 30 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

31. 31 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

32. 32 Hemorrhagic syndrome Hemorrhages appear in: Skin (petechiae) Mucous membrane Gastro-intestinal tract Intracranial Cardiac intrapulmonary

33. 33 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

34. 34 By the end of the phase Regeneration is noted in The bone marrow Lymph nodes

35. 35 Continued Are observed: Hypoproteinemia Hypoalbuminemia Reduction in the amount of chlorides in the hemopoietic system

36. 36 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

37. 37 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

38. 38 Continued The hemorrhages stop the dyspeptic phenomena disappear The mass of patients grows rapidly Gradual recovery of the blood indices occurs

39. 39 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

40. 40 Next The number of erythrocytes begins to grow In two or three months reaches its initial level

41. 41 The biochemical indices Of the blood and urine become normalized during this period

42. 42 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

43. 43 Treatment of the ARD Replacement of the loss in critical systems of cell renewal – the main task of pathogenic therapy

44. 44 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

45. 45 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