| YU Chang-lin,QIAO Jian-hui,LUO Wei-dong.Clinical report of one case of intestinal form of acute radiation sickness[J].Chinese Journal of Radiological Medicine and Protection,2007,27(1):11-16 |
| Clinical report of one case of intestinal form of acute radiation sickness |
| Received:September 18, 2006 |
| DOI： |
| KeyWords:Intestinal form of acute radiation sickness Haplo-identical HLA Stem cell transplantation Multiple organ failure |
| FundProject: |
| Author Name | Affiliation | E-mail | | YU Chang-lin | Department of Hematology, Affiliated Hospital, Academy of Military Medical Sciences, Beijing 100071, China | | | QIAO Jian-hui | Department of Hematology, Affiliated Hospital, Academy of Military Medical Sciences, Beijing 100071, China | | | LUO Wei-dong | Department of Hematology, Affiliated Hospital, Academy of Military Medical Sciences, Beijing 100071, China | | | 郭梅 | Department of Hematology, Affiliated Hospital, Academy of Military Medical Sciences, Beijing 100071, China | | | 王丹红 | Department of Hematology, Affiliated Hospital, Academy of Military Medical Sciences, Beijing 100071, China | | | 孙琪云 | Department of Hematology, Affiliated Hospital, Academy of Military Medical Sciences, Beijing 100071, China | | | 张石 | Department of Hematology, Affiliated Hospital, Academy of Military Medical Sciences, Beijing 100071, China | | | 陈建魁 | Department of Hematology, Affiliated Hospital, Academy of Military Medical Sciences, Beijing 100071, China | | | 李晓兵 | Department of Hematology, Affiliated Hospital, Academy of Military Medical Sciences, Beijing 100071, China | | | 艾辉胜 | Department of Hematology, Affiliated Hospital, Academy of Military Medical Sciences, Beijing 100071, China | huishengai@163.com |
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| Abstract:: |
| Objective To summarize the irradiation course, estimation of radiation dosage, clinical course, diagnosis and treatment of the patient A in a 60Co radiation accident on October 21, 2004 in Jining, Shandong Province, China. Methods According to the simulated test of the scene, chromosome aberration analysis, clinical course and tooth enamel ESR measurement, the total body dose of A was 20-25 Gy and diagnosed as intestinal form of acute radiation sickness. The patient was transferred to our hospital on day 3 post-irradiation, total environmental protection (TEP), antibiotics and emergency HLA-typing from his elder sister were given. On day 7 HLA haplo-identical peripheral blood stem cell transplantation was performed. Results On day 10 post-transplant (+10 d),the counts of WBC began to increase and up to 5.1×109/L on +12d. Bone marrow feature showed hematopoietic recovery of the three lineage blood cells. Continuous detection of the implantation ratio of donor's cells by STR-PCR showed stable 100% donor-derived chimera. On day 13, severe acute peritonitis and intestinal obstruction occurred; imipenem was much effective to control intestinal bacteria infection. Three days later, hematopoiesis reconstructed rapidly, peritonitis and intestinal obstruction were cured. On day 19, chest X-ray picture and CT scanning suggested that pulmonary mixed infection of bacteria and fungi appeared. The most severe skin irradiation burn damage occurred on day 25 which occupied the 14% of whole body skin surface. The functions of lung, heart and kidney were deteriorated sequentially. On day 30, tracheotomy had to be conducted and respirator was used. The patient died of multiple organ failure (MOF) on day 33. Conclusions Patient A was exposed to relative well-distributed high dose and high dose rate of irradiation up to 20-25 Gy. This is the first case report of successful HLA haplo-identical peripheral blood stem cell transplantation for intestinal form of acute radiation sickness in China, whose survival period prolonged to 33 days. The patient died of MOF due to excessive exposure and severe diffuse irradiation injury. The treatment of this patient was of great significance for the kind of such patients in the future. |
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