Medical Radiology and Radiation Safety. 2023. Vol. 68. № 1

DOI: 10.33266/1024-6177-2023-68-1-34-40

I.A. Galstian, A.Yu. Bushmanov, M.V. Konchalovsky, V.Yu. Nugis,
N.A. Metlyaeva, F.S. Torubarov, V.V. Korenkov, A.A. Davtian, D.A. Dubovoy

Features of the Dynamics of the Peripheral Blood Lymphocytes
during the First Week in Combined Radiation-Mechanical Lesions

A.I. Burnazyan Federal Medical Biophysical Center, Moscow, Russia

Contact person: I.A. Galstian, e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.



For a long time, the attention of researchers studying combined radiation-mechanical injuries (CRMI) has been focused on the study of individual syndromes: mechanical trauma and acute radiation syndrome. To diagnose and assess the severity of each syndrome, tests used for isolated injuries are recommended. However, the results of tests based on counting the number of different peripheral blood cells in an initially healthy person and in an injured patient who has experienced severe bleeding will be different. Accordingly, the assessment of the severity of developing acute radiation disease these patients will differ.

The possibility of predicting the severity of developing radiation injury in CRMI using a lymphatic test during the first week after exposure is also being evaluated. In this report, based on the literature data, the dynamics of the absolute number of lymphocytes in patients with multiple mechanical injuries is considered. 

The results of numerous clinical and experimental studies indicate that severe and multiple injuries, starting from the first hours and during the first week of observation, are characterized by instability of the number of lymphocytes in peripheral blood with significant absolute lymphopenia on the first day. It is shown that the depth of lymphopenia and the rate of recovery of the number of lymphocytes to normal values depends on the severity of the mechanical injury. In addition, the deepening of lymphopenia is also caused by urgent medical measures that are standard in the provision of medical care for severe trauma with blood loss: massive infusion therapy and the appointment of corticosteroids.

Thus, the use of a lymphocytic test in CRMI to assess the radiation dose without taking into account the significance of the trauma suffered will lead to a false prognosis of the degree of developing acute radiation damage, as well as to the lack of differentiation between the effects of radiation and non-radiation factors, and, consequently, to errors in patient management tactics.

Keywords: combined radiation-mechanical lesions, acute radiation sickness, biodosimetry, lymphocytes, lymphocyte test

For citation: Galstian IA, Bushmanov AYu, Konchalovsky MV, Nugis VYu, Metlyaeva NA, Torubarov FS, Korenkov VV, Davtian AA, Dubovoy DA. Features of the Dynamics of the Peripheral Blood Lymphocytes during the First Week in Combined Radiation-Mechanical Lesions. Medical Radiology and Radiation Safety. 2023;68(1):34–40. (In Russian). DOI: 10.33266/1024-6177-2023-68-1-34-40



1. Legeza V.I., Grebenyuk A.N., Boyarintsev V.V. Kombinirovannyye Radiatsionnyye Porazheniya i ikh Komponenty = Combined Radiation Damage and their Components. St. Petersburg, Foliant Publ., 2015. 215 p. (In Russ.).

2. Khoruzhenko A.F. Combined Radiation Damage in Emergency Situations of Peacetime and Wartime. Strategiya Grazhdanskoy Zashchity: Problemy i Issledovaniya. 2014;4;1:310-323
(In Russ.).

3. Legeza V.I., Timoshevskiy A.A., Grebenyuk A.N. Combined Radiation Damage. Meditsinskaya Sestra. 2017;2:18-21 (In Russ.).

4. Khromov B.M. Kombinirovannyye Luchevyye Porazheniya = Combined Radiation Injuries. Leningrad, Medgiz Publ., 1959. 344 p. (In Russ.).

5. Wood R.D. Leukogram Abnormalities in Animals. URL: (Access 04.07.2022).

6. Spenlingwimmer T., Zipperle J., Jafarmadar M., Osuchovski M.F., Drechsler S. Comparision of Post-Traumatic Changes in Circulating and Bone Marrow Leukocytes between BALB.c and CD-1 Mouse Strains. PLOS ONE. 2019;4;9:e0222594. DOI: 10.1371/journal.pone.0222594 (Access 04.07.2022).

7. Soulaiman E.S., Datal D., Al-Batool T.R., Walaa H., Niyazi I., Al-Ykzan H., Hussam A.S., Moufid D. Cohort Retrospective Study the Neutrophil to Lymphocyte Ratio as an Independent Predictor of Outcomes at the Presentation of the Multi-Trauma Patient International. International Journal of Emergency Medicine. 2020;13:5. DOI: 10.1186/s12245-020-0266-3.

8. Dhabhar F.S., Malarkey W.B., Neri E., McEwen B.S. Stress-Induced Redistribution of Immune Cells - From Barracks to Boulevards to Battlefields: a Tale of Three Hormones - curt richter award Winner. Psychoneuroendocrinology. 2012;37;9:1345-1368. doi: 10.1016/j.psyneuen.2012.05.008.

9. Dhabhar F.S., McEwen B.S. Stress-Induced Enhancement of Antigen-Specific Cell-Mediated Immunity. J. Immunology. 1996;156;7:2608–2615.

10. Kradin R., Rodberg G., Zhao L.H., Leary C. Epinephrine Yields Translocation of Lymphocytes to the Lung. Exp. Mol. Pathol. 2001;70;1:1–6. doi: 10.1006/exmp.2000.2342.

11. Dhabhar F.S., McEwen B.S. Acute Stress Enhances While Chronic Stress Suppresses Immune Function in Vivo: A Potential Role for Leukocyte Trafficking. Brain Behav Immun. 1997;11;4:286–306. doi: 10.1006/brbi.1997.0508.

12. Dhabhar F.S., McEwen B.S. Bidirectional Effects of Stress and Glucocorticoid Hormones on Immune Function: possible Explanations for Paradoxical Observations. Psychoneuroimmunology. Eds. Ader R., Felten D.L., Cohen N. San Diego, Academic Press, 2001. P. 301–338.

13. Viswanathan K., Daugherty C., Dhabhar F.S. Stress as an Endogenous Adjuvant: Augmentation of the Immunization Phase of Cell-Mediated Immunity. International Immunology. 2005;17;8:1059–1069. DOI: 10.1093/intimm/dxh286.

14. Viswanathan K., Dhabhar F.S. Stress-Induced Enhancement of Leukocyte Trafficking into Sites of Surgery or Immune Activation. Proc. Natl. Acad. Sci. USA. 2005;102;16:5808–5813. doi: 10.1073/pnas.0501650102.

15. Dhabhar F.S. Stress-Induced Enhancement of Cell-Mediated Immunity. Annals of the New York Academy of Sciences. 1998;840:359–372. doi: 10.1111/j.1749-6632.1998.tb09575.x.

16. Stefanski V., Peschel A., Reber S. Social Stress Affects Migration of Blood T Cells into Lymphoid Organs. J. Neuroimmunology. 2003;138;1-2:17–24. DOI: 10.1016/s0165-5728(03)00076-6.

17. Manson J., Hoffman R., Chen S., Ramadan M.H., Billiar T.R. Innate-Like Lymphocytes Are Immediate Participants in the Hyper-Acute Immune Response to Trauma and Hemorrhagic Shock. frontiers in immunology. 2019;10:1501. doi: 10/3389/fimmu.2019.01501. 

18. Vatnikov Yu.A. Characteristics of hematopoiesis in multiple injuries in dogs. Veterinarnaya Patologiya = Veterinary Pathology. 2012;4:45-48 (In Russ.).

19. Ustyantseva I.M. Laboratory Diagnostics for Polytrauma. Vrach Skoroy Pomoshchi = Emergency Doctor. 2019;1:26-39 (In Russ.).

20. Hazeldine J., Naumann D.N., Toman E., Davies D., Bishop R.B., SuZ., et al. Prehospital Immune Responses and Development of Multiple Organ Dysfunction Syndrome Following Traumatic Injury: A Prospective Cohort Study. PLoS Med. 2017;14;7:e1002338. doi: 10.1371/journal.pmed.1002338. 

21. Dong X., Wang C.., Lu S., Bai X, Li Z. The Trajectory of Alterations in Immune-Cell Counts in Severe-Trauma Patients is Related to the Later Occurrence of Sepsis and Mortality: Retrospective Study of 917 Cases. frontiers in immunology. 2021;11:603353. doi: 10.3389/fimmu.2020.603353. 

22. Manson J., Cole E., De’Ath H.D., Vulliamy P., Meier U., Pennington D., Brohi K. Early Changes Within the Lymphocyte Population Are Associated with the Development of Multiple Organ Dysfunction Syndrome in Trauma Patients. Critical Care. 2016;20:176. DOI 10.1186/s13054-016-1341-2. 

23. Jo S., Jeong T., Lee J.B., Jin Y., Yoon J.,ParkB. The Prognostic Value of Platelet-to-Lymphocyte Ratio on in-Hospital Mortality in Admitted Adult Traffic Accident Patients. Plos one. 2020;15;6:e0233838. doi: 10.1371/journal.pone.0233838

24. Ke R.-T., Rau C.-S., Hsieh T.-M., Chou S.-E., SuW.-T., Hsu S.-Y.,et al. Association of Platelets and White Blood Cells Subtypes with Trauma Patients’ Mortality Outcome in the Intensive Care Unit Healthcare. Healthcare. 2021;9:42. doi: 10.3390/healthcare9080942

25. Helmond van N., Jonson B.D., Curry T.B., Cap A.P., Convertino V.A., Joyner M.J.  White Blood Cell Concentrations During Lower Body Negative Pressure and Blood Loss in Humans. Exp. Physiol. 2016;101;10;1265-1275. DOI: 10.1113/EP085952.

26. Kim N.Y., Lim J., Lee S., Kim K., Hong J.H., Chun D.-H. Hematological Factors Predicting Mortality in Patients with Traumatic Epidural or Subdural Hematoma Undergoing Emergency Surgical Evacuation. Medicine. 2020;99:37(e22074). doi: 10.1097/MD.0000000000022074

27. Petrone A.B., Gionis V., Giersch R., Barr T.L. Immune Biomarkers for the Diagnosis of Mild Traumatic Brain Injury. NeuroRehabilitation. 2017;40;4:501–508. doi: 10.3233/NRE-171437.

28. Selidovkin G.D. Forecast of the Severity of the ARD for Early Clinical Manifestations. Radiatsionnaya Meditsina = Radiation Medicine. Guide for Research Doctors and Health Care Organizers. V.2. Ed. Ilyin L.A. Moscow, IzdAT Publ., 2001. P. 214-218 (In Russ.).

29. Baranov A.Ye, Konchalovsky M.V. Assessment of Irradiation Dose and Forecasting of the Bone Marrow Syndrome Severity by the Dynamics of Hematological Indicators. Radiatsionnaya Meditsina = Radiation Medicine. Guide for Research Doctors and Health Care Organizers. V.2. Ed. Ilyin L.A. Moscow, IzdAT Publ., 2001. P. 218-239 (In Russ.).

30. Baranov A.Ye. Acute Radiation Sickness: Biological Dosimetry, Early Diagnosis and Treatment, Outcomes and Long-Term Consequences. Radiatsionnyye Porazheniya Cheloveka = Human Radiation Damage. Eds. Bushmanov A.Yu., Reva V.D. Moscow, Slovo Publ., 2001. P. 53-84 (In Russ.).

31. Gruzdev G.P. Ostryy Radiatsionnyy Kostnomozgovoy Sindrom = Acute Radiation Bone Marrow Syndrome. Moscow, Meditsina Publ., 1988. 144 p. (In Russ.). 


 PDF (RUS) Full-text article (in Russian)

Conflict of interest. The authors declare no conflict of interest.

Financing. The study had no sponsorship.

Contribution. Article was prepared with equal participation of the authors.

Article received: 20.09.2022. Accepted for publication: 25.11.2022.