Pathophysiological principles underlying the blood cell concentration responses used to assess the severity of effect after accidental whole-body radiation exposure:: An essential basis for an evidence-based clinical triage
Pathophysiological principles underlying the blood cell concentration responses used to assess the severity of effect after accidental whole-body radiation exposure:: An essential basis for an evidence-based clinical triage
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DOI：
10.1016/j.exphem.2007.01.006
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发表时间：
2007-04-01
影响因子：
2.6
通讯作者：
Doorr, Harold
中科院分区：
文献类型：
--
作者：
Fliedner, Theodor M.;Graessle, Dieter;Doorr, Harold
客观的。本次综述的目的是为使用意外全身暴露于电离辐射后最初几天内粒细胞、血小板和淋巴细胞的变化模式作为其对造血干细胞池影响严重程度的令人信服的指标提供科学依据。 SEARCH 数据库系统（基于病史的辐射事故评估和归档系统）的可用性使我们能够分析 100 多名患者意外全身辐射暴露后的“早期”血细胞变化，并将其分配给效应代码 H4 和 113 的严重程度，如 METREPOL 方法中所述。结果。暴露后前 5 至 8 天内血细胞变化（粒细胞、血小板、淋巴细胞）的特定模式与分布在整个骨骼骨髓中的干细胞库（称为 H4）发生不可逆损伤的假设相一致。与这种模式不同的是，以“恢复失败”为特征的血细胞反应模式，可以用“受损细胞假说”来解释，允许将这些患者分配到与干细胞库“可逆”损伤的假设相一致的效应严重程度代码 H3、H2 或 HI。生物数学模型允许人们将血细胞变化模式与干细胞库受损程度联系起来。结论。外周血细胞计数的变化模式表明辐射对造血干细胞库的影响，并有可能预测自发再生。 (c) 2007 年国际实验血液学会。由爱思唯尔公司出版
Objective. The objective of this review is to provide a scientific justification for using the pattern of changes of granulocytes, platelets, and lymphocytes within the first few days after an accidental whole-body exposure to ionizing radiation as a convincing indicator of the severity of its effect on the hematopoietic stem cell pool.Method. The availability of the SEARCH database system (System for Evaluation and Archiving of Radiation Accidents based on Case Histories) allowed us to analyze the "early" blood cell changes after accidental whole-body radiation exposure in more than 100 patients and to assign them to severity of effect code H4 and 113, described in the METREPOL approach.Results. A specific pattern of blood cell changes (granulocytes, platelets, lymphocytes) within the first 5 to 8 days after exposure is compatible with the assumption of an irreversible damage of the stem cell pool distributed throughout the skeletal bone marrow designated as H4. Distinguishable from this pattern is a blood cell response pattern characterized by an "abortive recovery," which can be explained by the "injured cell hypothesis," allowing to assign these patients to a severity-of-effect-code H3, H2, or HI compatible with the assumption of a "reversible" damage to the stem cell pool. Biomathematical models allow one to correlate the blood cell change patterns with the extent of damage to the stem cell pool.Conclusion. Patterns of change in peripheral blood cell counts indicate the effect of radiation on the hematopoietic stem cell pool, and have the potential to predict autochthonous regeneration. (c) 2007 International Society for Experimental Hematology. Published by Elsevier Inc.