Hematopoietic Subsyndrome of Acute Radiation Syndrome (ARS)

• What is the hematopoietic subsyndrome of ARS?
• What is radiation exposure?
• Multimedia resources about exposure and the hematopoietic subsyndrome of ARS
• Estimate dose from exposure
• Perform targeted physical exam
• Consider these tools for clinical diagnosis and treatment
• Special clinical issues related to the hematopoietic subsyndrome
• References

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What is the hematopoietic subsyndrome of ARS?

• Hematologic subsyndrome is one of the 4 subsyndromes of ARS
  • Video explaining how to use the tool
• Dictionary definition of ARS

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What is radiation exposure?

• Animated illustrations

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Multimedia resources about exposure and the hematopoietic subsyndrome

• Multimedia resources
• Radiation effects on blood counts
  • Lymphocyte depletion kinetics graph (Andrews)
  • Radiation effects on blood counts (Verobiev)
  • Radiation effects on blood counts (Fliedner)
  • Radiation effects on blood counts (TMT Handbook)
• Time/dose effects in ARS
  • Interactive tool
  • Video explaining this tool
• Time phases of ARS
  • Interactive tool
  • Video explaining this tool
• Lethality as a Function of Dose and LD_50/60

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Estimate dose from exposure

• As the whole body or partial body dose from external exposure increases, the severity of the hematopoietic subsyndrome of ARS increases.
• Physical dosimeters worn over clothing can estimate/record dose from exposure, but during a mass casualty incident, it is unlikely that most members of the general public will be wearing physical dosimeters.
• Biodosimetry Tools to estimate dose from exposure
  • Explaining Biodosimetry - Frequently asked questions
  • Dose Estimator (Biodosimetry Interactive Tools)
    • Video explaining how to use the tool
• Dose Reconstruction - Location, duration, shielding

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Perform targeted physical exam

• Targeted physical exam

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Consider these tools for clinical diagnosis and treatment

• REMM clinical algorithm for exposure
  • Exposure algorithm
  • Video explaining the tool
• Other radiation injury management algorithms
• Expert consultation from the Radiation Injury Treatment Network (RITN)
• Manage ARS with scarce resources after an IND detonation
  • Interactive tool
  • Video explaining how to use the tool
• Template for adult/pediatric orders after a radiation incident

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Special clinical issues related to the hematopoietic subsyndrome

• Use of myeloid cytokines
• Management of febrile neutropenia
• Hematopoietic stem cell transplantation
• Use of Blood Products - guidance and warnings
• Burns and radiation exposure: combined injury
• Trauma and radiation exposure: combined injury
• Timing of surgery
• Multi-organ dysfunction syndrome

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References

See REMM Bibliography about Medical Management of Radiation Injury (Exposure)