The Possibilities of Early Diagnosis of Acute Radiation Syndrome Combined with Mechanical Injury

Purpose: To study the possibilities of using for early diagnosis of acute radiation bone marrow syndrome (ARBMS) combined mechanical injuries (CRMI) symptoms of the primary reaction to radiation (time of onset of nausea and vomiting, the multiplicity of the vomiting), as well as to assess the depth of absolute lymphopenia during the first week after radiation exposure.

Material and methods: 1. Comparative analysis of the literature data on the early symptoms of traumatic brain injury (TBI) and previously published own data on the primary reaction to radiation exposure in acute radiation syndrome (ARS) of varying severity in 134 victims on 04/26/1986 in the Chernobyl accident. 2. Comparative analysis of the dynamics of the absolute number of peripheral blood lymphocytes in 36 patients with mechanical polytrauma (average age – 40.24 ± 4.07 years) and 11 ARS I patients (comparison group 1, average age – 30.00 ± 2.01 years), as well as 15 ARS II patients (comparison group 2, average age – 28.47 ± 2.03 years). Statistical processing of the material is the IBM SPSS Statistics.23 software package, the Kraskal‒Wallis criteria and the Mann‒Whitney U-criterion for independent samples. The results obtained were considered statistically reliable at p <0.05.

Results: 1. Upon admission of a patient with suspected TBI within the framework of CRMI, who has nausea and vomiting, is unconscious and has damage to the skin of the head, dyspeptic syndrome cannot be considered only as a manifestation of the primary reaction to radiation. In the absence of suspicion of TBI, with clear consciousness and intact skin, nausea and vomiting can be used to predict the severity of developing ARBMS. 2. Analysis of the dynamics of peripheral blood lymphocytes in 15 (41.7 %) patients with polytrauma revealed absolute lymphopenia during the first week after mechanical exposure. At the same time, the depth of absolute lymphopenia in trauma without exposure to ionizing radiation at the time when it is usually examined and the severity of ARBMS is determined in individual patients corresponds to the indicators characteristic of ARS I and ARS II (can reach 0.3 × 10⁹/l).

Conclusions: The use of methods for early diagnosis of the severity of ARBMS will have some features in CRMI. The use of criteria for the primary reaction to radiation to diagnose the severity of developing ARBMS can be recommended only if the patient has no obvious signs of TBI: consciousness is preserved, there are no signs of mechanical trauma in the head area (hematomas, abrasions, open wounds, bone fractures). In 42 % of patients with mechanical polytrauma, posttraumatic fever may be detected during the first week of follow-up post-traumatic absolute lymphopenia in combination with post-traumatic absolute lymphopenia can lead to an overestimation of the severity of developing ARBMS. The final decision on the prognosis of the severity of ARBMS, as well as CRMI in general and patient management tactics should be made only after evaluating the absorbed dose by cytogenetic method.