Document Detail


Radiation victim management and the haematologist in the future: time to revisit therapeutic guidelines?
MedLine Citation:
PMID:  20597842     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: The use of nuclear/radiation devices against the civilian population is now a realistic scenario. Haematopoietic syndrome is the primary therapeutic challenge in the case of whole body acute exposure over 2 Grays (Gy) whereas burns and combined injuries would be frequently observed in myelo-suppressed patients. Optimisation of scoring and treatments are important goals to achieve.
CONCLUSION: The European Response Category (RC) concept represents an attempt to integratively assess haematological/extrahematological radiation-induced lesions. Based on the frequently observed heterogeneity of bone marrow damage in accidental/intentional irradiations, the stimulation of residual stem cells using granulocyte Colony-stimulating factor remains the therapeutic standard after exposure to less than the lethal dose 50 % (Haematopoietic[H] score 3-H3). Allogeneic stem cell transplantation is indicated in case of medullary eradication (Haematopoietic score 4-H4) whereas extramedullary toxicity may determine the outcome. Especially in case of numerous casualties exhibiting acute radiation syndrome, the administration of survival factor combinations remains questionable, at least as a palliative treatment. In addition pleiotropic cytokines injection such as erythropoietin and keratinocyte growth factor and grafting multipotent mesenchymal stem cells - from underexposed bone marrow areas or fat tissues - could be proposed to prevent multiple organ failure syndrome development. Multi-disciplinary teams should be prepared to manage such patients.
Authors:
Michel Drouet; Francis Hérodin
Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  International journal of radiation biology     Volume:  86     ISSN:  1362-3095     ISO Abbreviation:  Int. J. Radiat. Biol.     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-08-02     Completed Date:  2010-08-25     Revised Date:  2013-05-20    
Medline Journal Info:
Nlm Unique ID:  8809243     Medline TA:  Int J Radiat Biol     Country:  England    
Other Details:
Languages:  eng     Pagination:  636-48     Citation Subset:  IM; S    
Affiliation:
IRBA-antenne La Tronche-CRSSA, La Tronche, France. micheldrouet@crssa.net
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MeSH Terms
Descriptor/Qualifier:
Animals
Apoptosis
Cytokines / therapeutic use
Hematology*
Hematopoietic Stem Cell Transplantation
Humans
Multiple Organ Failure / etiology
Practice Guidelines as Topic*
Radiation Dosage
Radiation Injuries / therapy*
Radioactive Hazard Release*
Skin / radiation effects
Thrombopoiesis / drug effects
Chemical
Reg. No./Substance:
0/Cytokines

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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