Medical Radiology and Radiation Safety. 2025. Vol. 70. № 1
DOI:10.33266/1024-6177-2025-70-1-53-59
I.A. Galstian, A.Yu. Bushmanov, F.S. Torubarov, Z.F. Zvereva,
O.V. Shcherbatykh, V.Yu. Nugis, N.A. Metlyaeva, V.I. Pustovoit,
A.S. Umnikov, M.V. Konchalovsky, A.V. Aksenenko, V.V. Korenkov,
L.A. Yunanova, O.G. Kashirina
The Possibilities of Early Diagnosis of Acute Radiation Syndrome Combined with Mechanical Injury
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.
ABSTRACT
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.
Keywords: combined radiation-mechanical injury, acute radiation bone marrow syndrome, traumatic brain injury, biodosimetry, early diagnosis, primary reaction to radiation, lymphocyte test
For citation: Galstian IA, Bushmanov AYu, Torubarov FS, Zvereva ZF, Shcherbatykh OV, Nugis VYu, Metlyaeva NA, Pustovoit VI, Umnikov AS, Konchalovsky MV, Aksenenko AV, Korenkov VV, Yunanova LA, Kashirina OG. The Possibilities of Early Diagnosis of Acute Radiation Syndrome Combined with Mechanical Injury. Medical Radiology and Radiation Safety. 2025;70(1):53–59. (In Russian). DOI:10.33266/1024-6177-2025-70-1-53-59
References
1. Voyenno-Polevaya Khirurgiya = Military Field Surgery. Textbook. Ed. Gumanenko Ye.K. Moscow, Geotar-Media Publ., 2022. 768 p. (In Russ.).
2. Voyenno-Polevaya Khirurgiya = Military Field Surgery. Ed. Samokhvalov I.M. National Guide. Moscow, Geotar-Media Publ., 2023. 1056 p. (In Russ.).
3. Radiatsionnaya Meditsina Rukovodstvo dlya Vrachey-Issledovateley i Organizatorov Zdravookhraneniya. T. 1. Teoreticheskiye Osnovy Radiatsionnoy Meditsiny = Radiation Medicine. A Guide for Medical Researchers and Healthcare Organizers. Vol. 1. Theoretical Foundations of Radiation Medicine / Ed. Il’in L.A. Moscow, IzdAT Publ., 2001. 992 p. (In Russ.).
4. Khromov B.M. Kombinirovannyye Luchevyye Porazheniya = Combined Radiation Injuries. Leningrad, Medgiz Publ., 1959. 343 p. (In Russ.).
5. Sarkisov A.A., Vysotskiy V.L. Nuclear Accident in Chazhma Bay. Reconstruction of Events and Analysis of Consequences. Vestnik RAN = Bulletin of the Russian Academy of Sciences. 2018;88;7:599-618 (In Russ.).
6. Barabanova A.V., Baranov A.Ye., Bushmanov A.Yu., et al. Ostraya Luchevaya Bolezn’ Cheloveka. Atlas. CH. 1. Postradavshiye pri Radiatsionnoy Avarii na CHAES 1986 g = Acute Radiation Sickness in Humans. Atlas. Part 1. Victims of the 1986 Chernobyl Radiation Accident. Ed. A.S. Samoylov, V.Yu. Solov’yev. Moscow, FMBTS im. A.I. Burnazyana FMBA Rossii Publ., 2017. 139 p. (In Russ.).
7. Legeza V.I., Grebenyuk A.N., Boyarintsev V.V. Kombinirovannyye Radiatsionnyye Porazheniya i ikh Komponenty = Combined Radiation Injuries and their Components. St. Petersburg, Foliant Publ., 2015. 216 p. (In Russ.).
8. 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.
9. 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.
10. 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.
11. Gayvoronskaya V.I., Persichkina N.V. Diagnostic Significance of Clinical and Morphological Manifestations of Traumatic Brain Injury of Varying Severity. Problemy Ekspertizy v Meditsine = Problems of Examination in Medicine. 2001;1;4:17-19 (In Russ.).
12. Torubarov F.S., Zvereva Z.F., Galstyan I.A., Metlyayeva N.A. Features of Clinical Manifestations of the Primary Reaction in Combined Radiation Damage (Radiation Exposure and Mechanical Head Injury). Radiatsionnaya Meditsina = Radiation Medicine. 2023;68;3:16-20 (In Russ.).
13. M’kacher R., Maalouf E.E.L., Ricoul M., Heidingsfelder L., Laplagne E., Cuceu C., et al. New Tool for Biological Dosimetry: Reevaluation and Automation of the Gold Standard Method Following Telomere and Centromere Staining. Mutat. Res. 2014;770;1:45-53. doi: 10.1016/j.mrfmmm.2014.09.007.
14. Abe Yu., Yoshida M.A., Fujioka K., Kurosu Y., Ujiie R., Yanagi A., Tsuyama N., Miura T., Inaba T., Kamiya K., Sakai A. Dose–Response Curves for Analyzing of Dicentric Chromosomes and Chromosome Translocations Following Doses of 1000 mGy or Less, Based on Irradiated Peripheral Blood Samples from Five Healthy Individuals. Journal of Radiation Research. 2018;59;1:35–42. doi: 10.1093/jrr/rrx05.
15. Rogan P.K., Mucaki E.J., Shirley B.C., Li Y., Wilkins R., et al. Automated Cytogenetic Biodosimetry at Poplation-Scale. Radiation. 2021;1:79-94. doi: 10.3390/radiation1020008.
16. Pyatkin Ye.K., Pokrovskaya V.N., Triska V.V. Frequency of Chromosomal Aberrations in Cultures of Human Bone Marrow and Peripheral Blood Lymphocytes After γ-Irradiation in vitro. Meditsinskaya Radiologiya = Medical Radiology. 1980;25;2:44-48 (In Russ.).
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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: 20.10.2024. Accepted for publication: 25.11.2024.