Radiation Effects on Blood Counts (2) - Illustration - Radiation Emergency Medical Management

Radiation Effects on Blood Counts (2) - Illustration - Radiation Emergency Medical Management

Comment and 2017-2018 Updates

• A retrospective study of 153 accidental radiation exposure cases (mostly from Chernobyl and Goiania) compared whole body dose estimates from the dicentric chromosome assay (DCA) to H1-H4 status assigned from CBCs as shown in the graphs and text above. Researchers showed that
  • Single whole-body radiation doses (from DCA) of < 1 Gy and > 5 Gy corresponded in general with H0 and H3-4 respectively, consistent with medical expectations. This indicates that the extreme values for the 2 testing methods (CBC and DCA) correlated reasonably well.
  • However, whole body doses (suggested by DCA) for between 1-5 Gy corresponded poorly to hematopoietic-ARS categories H1-3.Although the study had limitations, the data suggest that DCA results suggesting doses between 1 and 5 Gy are of limited value for medical decision-making regarding key triage issues such as (a) hospitalization for H2-3, but not H1 and (b) treatment decisions that differentiate between H1-3.
  • Also, there were some H0 cases who were predicted to have high dose by the DCA, and some H2-4 cases predicted by DCA to have low dose.
  • These data create concerns about using individual recommendations based solely on DCA (and perhaps other methods’) estimates of whole-body dose. Using clinical data from CBC results appear to provide more useful context for clinical decision making.
  • Source of this update: Port M, Pieper B, Dorr HD, Hubsch A, Majewski M, Abend M, Correlation of Radiation Dose Estimates by DIC with METREPOL Hematological Classes of Disease Severity. Radiat Res. 2018 May;189(5):449-455. [PubMed Citation]
• The same group has published additional data about the validity and utility of using CBCs for decision-making. Their model also suggests how to consider triage and transport actions based on their H-ARS algorithm result.
  • Port M, Pieper B, Knie T, Dorr H, Ganser A, Graessle D, Meineke V, Abend M. Rapid Prediction of Hematologic Acute Radaition Syndrome in Radiation Injury Patients Using Peripheral Blood Cell counts. Radiat Res. 2017 Aug;188(2):156-168. [PubMed Citation]