A severe radiation accident occurred on Tuesday, 14 June 2011 in an industrial irradiation facility. Five people were exposed for 5-10 min to (60)Co source (137 TBq-3710 Ci). This accident was the first one in Bulgaria, in which the whole-body irradiation doses exceeded 1 Gy and suggested the development of acute radiation syndrome (ARS). This report discusses the diagnostic features of ARS and the use of the METREPOL concept and its diagnostic criteria in assessing the severity of radiation damage. The results used in this study show that injury assessment based only on prodromal symptoms is burdened with a serious error. The probable reasons are at least two: one is the unwillingness of victims to be diagnosed as involved in radiation emergency, which could reflect on their working status, and the other is the slight manifestation of symptoms due to the specific geometry of irradiation. The European Guideline for Medical Management of ARS is a good basis for an early diagnosis of radiation injury.
A severe radiation accident occurred on 14 June 2011 in an industrial irradiation facility for medical equipment sterilization in Bulgaria. Five people were exposed for 5-10 min to a 60Co source containing 137 TBq. The Emergency Department of the National Centre of Radiobiology and Radiation Protection (NCRRP), Bulgaria, put into practice the plans for providing medical care in radiation accidents and the procedures developed for assessment of injury severity, the decision-making algorithm regarding subsequent treatment, and the therapy for persons affected. The activities performed for initial assessment of the severity of injury of irradiated patients were published in 2012. Based on predictive assessments of the severity of radiation damage, it was decided that the victims required hospitalization at a specialized hematology clinic. Percy Hospital in Paris was chosen for this purpose. The aim of this report is to present the results of 1-y follow-up for three of the victims. Sadly, 1 mo after the accident, Patient 4 died from a heart attack. The medical opinion was that this was not a direct outcome of the irradiation. Patient 5 was only followed up for 4 mo (118 d) because medical follow-up is voluntary, and despite repeated calls, the patient did not respond. Medical examinations by a physician as well as hematology and biochemical tests were performed using standard laboratory methods. The obtained results were compared to the victims' personal reference limits obtained from annual health monitoring. After the accident, the recovery to normal content of peripheral blood cells was observed in all victims. Nevertheless, there were observed cases of thrombocytopenia, granulocytopenia, and leucocytopenia at various times after exposure. During the period of observation, morphological changes in red blood cells such as anisomicrocitosis, macrocytes, megalocytes, and polychromatic erythrocytes were demonstrated. During the 1-y observation period, all victims showed immediate hematopoietic recovery within 2 mo after irradiation. Slight hypocellularity of bone marrow was noted at the end of the year.
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