DISASTER MEDICINE No. 3•2021
Peculiarities of Using Lymphocyte Test to Predict the Severity of Acute Radiation Injury
Download the article in pdf format
Lebedev A.O.1, Samoylov A.S.1, Solovyev V.Yu.1, Baranova N.N.1, Gudkov E.A.1
1 State Research Center – Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency, Moscow, Russian Federation
2 Russian Medical Academy of Continuous Professional Education, the Ministry of Health of the Russian Federation, Moscow, Russian Federation
Abstract. One of the methods of biological dosimetry is the use of information on the concentration of lymphocytes in the peripheral blood of victims in the first days after irradiation.
The aim of the study was to validate the lymphocyte test method for predicting the severity of acute radiation injury, taking into account the dose rate factor.
Materials and research methods. The method of investigation was a correlational analysis of clinical, dosimetric and laboratory data of the victims of the accident at the Chernobyl nuclear power plant in 1986 (n=65) and in radiation accidents with gamma-neutron irradiation (n=19). The data were taken from the database of acute radiation injuries in humans of A.I. Burnazyan Federal Medical Biophysical Center of the Federal Medical and Biological Agency of Russia.
Results of the study and their analysis. The results of correlation analysis indicated that average lymphocyte concentration in the range of 0.4-0.8×109/l on day 3-6 post-irradiation with dose rates greater than 2 Gy/h resulted in an average dose estimate which was 40.0% higher than that for dose rates of less than 2 Gy/h. Absolute error of dose estimation is (±1.0-1.5) Gy. For lymphocyte concentrations higher than 0.8×109/l the prognosis is uncertain: the range of dose assessment variability is 1-4 Gy. At a lymphocyte concentration of less than 0.4×109/l the average dose estimate is more than 4.0 Gy, corresponding to a severe or extremely severe degree of acute radiation disease. The predicted degree of severity of radiation injuries in the presence of the neutron component of radiation is lower in comparison with the predictions based on the data on the victims of the Chernobyl accident. It is concluded that the identified dependencies can be used for medical triage of the victims at advanced stages of medical evacuation. For the purpose of correct routing of medical evacuation to specialized centers, it is advisable to allocate 4 treatment-evacuation groups.
Keywords: dosimetry, treatment and evacuation groups, lymphocyte test, routing, medical triage, medical evacuation, prognosis, radiation accidents, severity of radiation injuries, emergencies
For citation: Lebedev A.O., Samoylov A.S., Solovyev V.Yu., Baranova N.N., Gudkov E.A.
Peculiarities of Using Lymphocyte Test to Predict the Severity of Acute Radiation Injury. Meditsina katastrof = Disaster Medicine. 2021;3:29-33 (In Russ.). https://doi.org/10.33266/2070-1004-2021-3-29-33
- Goans R.E., Holloway E.C., Berger M.E., Ricks R.C. Early Dose Assessment in Criticality Accidents. Health Physics. 2001;81:446–449.
- Goans R.E., Waselenko J.K. Medical Management of Radiological Casualties. Health Physics. 2005;89;5:505-512.
- Goans R.E. Clinical Care of the Radiation-Accident Patient: Patient Presentation, Assessment, and Initial Diagnosis. The Medical Basis for Radiation-Accident Preparedness: The Clinical Care of Victims. Washington, DC, Parthenon, 2002. P. 11-22.
- Parker D.D., Parker J.C. Estimating Radiation Dose from Time to Emesis and Lymphocyte Depletion. Health Physics. 2007;93;6:701-704.
- Goans R.E., Holloway E.C., Berger M.E., Ricks R.C. Early Dose Assessment Following Severe Radiation Accidents. Health Physics. 1997;72;4:513-518.
- Waselenko J.K., et al. Medical Management of the Acute Radiation Syndrome: Recommendations of the Strategic National Stockpile Radiation Working Group. Annals of Internal Medicine. 2004;40;12:1037-1051.
- The Medical Aspects of Radiation Incidents.4th Edition. Oak Ridge, DE-SC0014664. 2017. 60 p. URL: https://orise.orau.gov/resources/reacts/documents/medical-aspects-of-radiation-incidents.pdf.
- Dainiak N. Hematologic Consequences of Exposure to Ionizing Radiation. Experimental Hematology. 2002;30;6:513-528.
- Coleman C.N., et al. Triage and Treatment Tools for Use in a Scarce Resources-Crisis Standards of Care Setting After A Nuclear Detonation. Disaster Medicine and Public Health Preparedness. 2011;5;S1:111-121.
- Baranov A.E. Acute Radiation Sickness: Biological Dosimetry, Early Diagnosis and Treatment, Outcomes and Long-Term Consequences. Human Radiation Damage. Selected Clinical Lectures, Methodological Manual. Ed. By A.Yu. Bushmanov, V.D. Reva. Moscow, Slovo Publ., 2007. P. 53-84 (In Russ.).
- Solovyev V.Yu., Nugis V.Yu., Khamidulin T.M., Krasnyuk V.I. Research of Haematological Criteria’s Prognostic Value in Radiation Injuries Severity Assessment. Medline.ru: Russian Biomedical Electronic Journal. 2011;12;35:420-430. URL: http://www.medline.ru/public/art/tom12/art35.html (In Russ.)
- Solovyev V.Yu. Mathematical Methods and Models in Emergency Dosimetry, Radiation Medicine and Radiation Epidemiology. Moscow, SRC-FMBC Publ, 2016. 120 p. (In Russ.).
- ATLAS. Acute Radiation Syndrome. Ed. by A.S. Samoylov and V.Yu. Solovyev. Moscow, SRC-FMBC Publ., 2019. 232 p.
The material was received 28.05.21; the article after peer review procedure 12.07.21; the Editorial Board accepted the article for publication 10.09.21