Medical follow-up of four cases with bone marrow form of acute radiation sickness twelve years after the accident

Objective: To investigate the late effects of ionizing radiation, in order to provide information and gain experience for medical treatments in nuclear accident emergencies, by medical follow-up of the four cases with bone marrow form of acute radiation sickness who were exposed to ⁶⁰Co accidentally in 1999. Methods: Histories were taken by one or several doctors, who observed and wrote down the clinical symptoms of the patients. The general health situation was evaluated by laboratory and equipment examinations, including blood cells, liver and kidney function, thyroid function, humoral immunity, levels of sex hormones, tumor markers and ophthalmic examination, thyroid ultrasonography, abdominal ultrasound, ECG and chest X-ray examination. The radiation genetics analysis was performed by chromosome aberration and micronucleus assay (CB method). Real-time PCR was used to quantify the expressions of peripheral blood GADD45 and nm23-H1 gene mRNA, which were compared with the control group. The psychological qualities of patients were evaluated by 16PF, SDS, SAS. Results: The hematopoietic system and immune function had basically returned to normal 12 years after the accident. HBV markers showed that HBsAg and HBcAb of Tian were positive, which showed that infectivity was weak. All of their eye lenses had varying degrees of turbidity changes, Mei had radiation-incuded cataract 3 years after irradiation. The levels of sex hormones of Mei, Tian, Min were abnormal. Translocation could be seen by analysis of peripheral blood lymphocyte chromosome aberration. The expressions of GADD45 and nm23-H1 gene mRNA had no significant difference with the control group. Psychological tests showed that the radiation incident caused different degrees of mental disorder to the exposed individuals. Conclusions: The medical follow-up and psychological evaluation of four cases with bone marrow form of acute radiation sickness are successful, which provides information for clinical treatment and medical follow-up of similar cases. (authors)