Features of Using the Lymphocyte Test to Determine the Degree of Severity of Acute Radiation Bone Marrow Syndrome in Combined Radiation and Mechanical Injury
Authors:   A.I. Burnazyan Federal Medical Biophysical Center, Moscow, Russia, Galstian I.A. , Bushmanov A.Yu. ,   A.I. Burnazyan Federal Medical Biophysical Center, Moscow, Russia, Shcherbatykh O.V. ,   A.I. Burnazyan Federal Medical Biophysical Center, Moscow, Russia, Nugis V.Yu. ,   A.I. Burnazyan Federal Medical Biophysical Center, Moscow, Russia, Metlyaeva N.A. ,   A.I. Burnazyan Federal Medical Biophysical Center, Moscow, Russia, Konchalovsky M.V. ,   A.I. Burnazyan Federal Medical Biophysical Center, Moscow, Russia, Pustovoit V.I. ,   A.I. Burnazyan Federal Medical Biophysical Center, Moscow, Russia, Umnikov A.S. ,   A.I. Burnazyan Federal Medical Biophysical Center, Moscow, Russia, Aksenenko A.V. ,   A.I. Burnazyan Federal Medical Biophysical Center, Moscow, Russia, Chekinev K.E. ,   Tomsk Regional Clinical Hospital, Tomsk, Russia, Kerimov A.A. ,   N.N. Burdenko Main Military Clinical Hospital, Moscow, Russia, Grechukhin D.A. ,   N.N. Burdenko Main Military Clinical Hospital, Moscow, Russia, Yunanova L.A. ,   A.I. Burnazyan Federal Medical Biophysical Center, Moscow, Russia, Davtian A.A. ,   A.I. Burnazyan Federal Medical Biophysical Center, Moscow, Russia, Dubovoy D.A. ,   A.I. Burnazyan Federal Medical Biophysical Center, Moscow, Russia, Soloviev V.Yu. ,   A.I. Burnazyan Federal Medical Biophysical Center, Moscow, Russia
Published: December 2024

Purpose: To study the effect of the phenomenon of mutual aggravation on the early diagnosis of the severity of acute radiation bone marrow syndrome (ARBMS), which develops within the framework of combined radiation-mechanical injury (CRMI).

Material and methods: According to the general blood test data, the dynamics of the relative and absolute number of lymphocytes in 36 patients was studied during the first 10 days after receiving polytrauma. There are 35 men and one woman among them. The average age of the victims at the time of injury was 40.24 ± 4.07 years. The number of studied blood tests in one patient varied from one to 16 during the specified follow–up period (on average, 6). The dynamics of the absolute number of lymphocytes at the same time was also studied in 11 patients (men, average age – 30.00 ± 2.01 years) diagnosed with acute radiation syndrome (ARS) I and in 15 men diagnosed with ARS II (average age – 28.47 ± 2.03 years). Statistical processing of the material was performed using the IBM SPSS Statistics software package.23 using the Kraskal–Wallis criteria and the Mann–Whitney U-test for independent samples. The differences between the obtained results were considered statistically significant at p < 0.05.

Results: Relative lymphopenia was detected in 25 (69.4 %) patients diagnosed with polytrauma. A combination of absolute and relative lymphopenia was found in 15 (41.7 %) patients. Only transient relative lymphopenia was detected in 10 patients. The depth of absolute lymphopenia detected in polytrauma was compared with a similar indicator at the same time in ARS I and ARS II. The depth of absolute lymphopenia in trauma without exposure to ionizing radiation at the time when it is usually studied to determine the severity of ARBMS reached the indicators characteristic of ARS I and ARS II (up to 0.3–0.5 × 109/L.). At the same time, the nature of the dynamics of the absolute number of lymphocytes in trauma is radically different from that in acute radiation exposure.

Conclusion: The data obtained allow us to consider the possible deepening of absolute lymphopenia in CRMI in 42 % of cases as one of the manifestations of the phenomenon of mutual aggravation, which can lead to an early aggravation of the predicted severity of the developing ARBMS. The data obtained indicate that this weighting may be + 1, in rare cases +2 degrees of severity of ARS to the true degree of severity corresponding to the absorbed dose of radiation exposure.