GBZ 99-2002 Diagnostic criteria for subacute radiation sickness caused by external exposure

This standard specifies the diagnostic criteria and treatment principles for subacute radiation sickness caused by external exposure. This standard is applicable to occupational radiation workers who are exposed to continuous or intermittent high-dose external radiation for a long time under accidental exposure. GBZ 99-2002 Diagnostic Standard for Subacute Radiation Sickness Caused by External Exposure GBZ99-2002 Standard Download Decompression Password: www.bzxz.net

ICS13.100
National Occupational Health Standard of the People's Republic of China GBZ99-2002
Diagnostic criteria for subacute radiation sickness from externalexposure
Published on April 8, 2002
Published by the Ministry of Health of the People's Republic of China
Implemented on June 1, 2002
Chapters 2, 3, and 4 of this standard are mandatory, and the rest are recommended. GBZ99-2002
This standard is specially formulated in accordance with the Law of the People's Republic of China on the Prevention and Control of Occupational Diseases. In case of any inconsistency between the original standard GB16388-1996 and this standard, this standard shall prevail. Subacute radiation sickness from external exposure refers to a systemic disease caused by continuous or intermittent high-dose external radiation exposure to the human body for a long period of time (weeks to months). Usually, the onset is insidious, the stages are not obvious, and there is no asthenic neurasthenia syndrome. Clinically, the main symptom is hematopoietic dysfunction. According to the symptoms and the degree of hematopoietic damage, it is divided into mild and severe degrees.
Appendix A and Appendix B of this standard are both informative appendices. This standard is proposed and managed by the Ministry of Health of the People's Republic of China. The drafting unit of this standard is the Affiliated Hospital of the Academy of Military Medical Sciences. The main drafters of this standard are Jiang Benrong and Ye Genyao. This standard is interpreted by the Ministry of Health of the People's Republic of China. 1 Scope
Diagnostic criteria for subacute radiation sickness caused by external exposure
This standard specifies the diagnostic criteria and treatment principles for subacute radiation sickness caused by external exposure. GBZ99-2002
This standard is applicable to occupational radiation workers who are exposed to continuous or intermittent large doses of external radiation for a long time under accidental irradiation.
Non-radiation workers who are accidentally exposed to subacute radiation sickness can also refer to this standard for diagnosis and treatment. If radiation workers or non-radiation workers are indeed exposed to this disease due to work, their treatment and treatment shall be handled in accordance with relevant national regulations.
2 Diagnostic principles
It is necessary to make a correct diagnosis based on the exposure history, exposure dose, clinical manifestations and laboratory test findings, combined with a comprehensive analysis of the health records, exclude other diseases. 3 Diagnostic criteria
3.1 Continuous or intermittent cumulative external irradiation greater than 1Gy of uniform whole-body dose over a long period of time (weeks to months).
3.2 Pancytopenia and related symptoms
3.3 Lymphocyte chromosome aberrations include both unstable aberrations induced by recent irradiation and stable aberrations remaining from early irradiation, both of which are increased. 3.4 Bone marrow examination shows decreased proliferation. If the proliferation is active, there must be a significant decrease in megakaryocytes and an increase in lymphocytes. 3.5 Other diseases that can cause pancytopenia can be excluded, such as paroxysmal nocturnal hemoglobinuria, refractory anemia in myelodysplastic syndrome, acute hematopoietic stagnation, myelofibrosis, acute leukemia, malignant histiocytosis, etc.
3.6 General anti-anemia drugs are ineffective.
3.7 May be accompanied by abnormalities in the following examinations:
a. Microcirculation disorder;
b. Low immune function;
c. Coagulation disorder:
d. Low reproductive function.
4 Grading standard
4.1 Mild bzxZ.net
GBZ99-2002
4.1.1 Slow onset. Anemia, infection, and bleeding are mild. The blood count decreases slowly, and the bone marrow is damaged to a certain extent. 4.1.2 Blood count: Hemoglobin <120g/L for men, <100g/L for women, white blood cell count <4×10/L, platelet count <80×10/L. In the early stage, only 1-2 of these abnormalities may appear. 4.1.3 Bone marrow picture: reduction of two or three lines of the granulocyte, erythrocyte and megakaryocyte system in the bone marrow, poor proliferation in at least one part, and a significant reduction in megakaryocytes.
4.1.4 Recovery is expected after adequate treatment away from radiation. 4.2 Severe
4.2.1 Acute onset, progressive aggravation of anemia, often accompanied by infection and bleeding. 4.2.2 Blood picture: hemoglobin <80g/L, reticulocyte <0.5%, leukocyte <1.0×10/L, absolute value of neutrophils <0.5×10°/L, platelets <20×10/L. 4.2.3 Bone marrow picture: hypoplasia in multiple parts, significant reduction in granulocyte, erythrocyte and megakaryocyte hematopoietic cells, if proliferation is active, lymphocyte increase is required.
4.2.4 After being away from radiation and receiving adequate treatment, the patient recovers slowly or cannot prevent the disease from worsening. The patient may be transformed into myelodysplastic syndrome or leukemia, and the prognosis is poor. 5 Treatment principles
Apply the following principles according to the severity of the disease and clinical characteristics. 5.1 After being away from radiation exposure, drugs that are not conducive to hematopoiesis are prohibited. 5.2 Protect and promote the recovery of hematopoietic function. Male hormones or protein anabolic hormones can be used in combination with drugs that improve microcirculation function, such as 654-2.
5.3 Correct anemia and supplement various blood components to prevent and treat complications caused by hematopoietic dysfunction. 5.4 Enhance the body's resistance, intramuscular injection of immunoglobulin, and for patients with severe cases with low immune function, intravenous infusion of immunoglobulin or application of enhancers can be used. 5.5 When the white blood cell count is <1.0×10/L, protective isolation should be implemented. 5.6 Other symptomatic treatments such as anti-infection and anti-bleeding. 5.7 Pay attention to rest, strengthen nutrition, and pay attention to psychological care. 6 Principles of treatment of subacute radiation sickness
GBZ99-2002
After the condition stabilizes, conduct close medical follow-up observation and regular health examinations. Pay attention to possible long-term effects and take corresponding measures. According to the recovery situation, patients can be treated, rested or arranged for appropriate non-radioactive work. For those whose recovery is not complete and affects their ability to live or work, their disability level will be assessed in accordance with relevant national regulations and they will enjoy corresponding treatment stipulated by the state in accordance with the law
A.1 Microcirculation Appendix A
(Informative Appendix)
GBZ99-2002
Microcirculation is the circulation dynamics of body fluids (blood, tissue fluid, lymph) that directly participate in the exchange of substances. The microcirculation that can be directly observed clinically is limited to the blood circulation part. The parts commonly used to observe the state of microcirculation are nail folds, conjunctiva, fundus, etc.
A.2 Myelodysplastic syndrome (MDS) is a group of diseases characterized by abnormal quality and quantity of three-lineage hematopoietic cells and their precursor cells in the bone marrow. Some patients may transform into leukemia. MDS can be divided into five types: refractory anemia (RA), refractory anemia with ringed sideroblasts (RAS), refractory anemia with excess blasts (RAEB), refractory anemia with excess blasts in transformation (RAEB-T), and chronic myelomonocytic leukemia (CMML). Appendix B
Instructions for the correct use of this standard
(Informative Appendix)
GBZ99-2002
B.1 The stages of subacute radiation sickness caused by external irradiation are not obvious: The stages referred to here are the initial stage, pseudo-healing stage, extreme stage and recovery stage of typical acute radiation sickness of bone marrow. This type of patient has no obvious clinical stage, which is different from acute radiation sickness caused by external irradiation within a certain dose range. B.2 No obvious asthenic neurasthenia syndrome: Asthenic neurasthenia syndrome here refers to a syndrome in which the patient has obvious symptoms such as fatigue, loss of appetite, shortness of breath, difficulty falling asleep, frequent dreams and easy awakening, forgetfulness, sexual dysfunction, etc. In addition to the symptoms related to pancytopenia such as weakness, dizziness, and palpitations, the above symptoms are rare in patients with subacute radiation sickness, which is different from chronic radiation sickness with asthenic neurasthenia syndrome as the main clinical manifestation. B.3 Microcirculatory disorders: In this type of patients, microcirculatory examinations such as nail folds, conjunctiva, fundus vessels, and forehead impedance volume waves that reflect microcirculatory disorders are obviously abnormal, which can be distinguished from primary aplastic anemia.
B.4 In the chromosome examination of this type of patients, both unstable aberrations induced by recent exposure and stable aberrations remaining from early exposure can be seen. This feature is different from the patients with acute radiation sickness with unstable aberrations as the main clinical manifestation. This is different from primary aplastic anemia, where chromosomal aberrations are not obvious or absent.
B.5 Regarding the degree of classification: referring to the diagnostic criteria for aplastic anemia, this type of radiation sickness is divided into mild and severe degrees. However, in actual work, some indicators of some patients may meet the requirements of severe disease, while others may meet the requirements of mild disease. In this case, a comprehensive analysis and even a long period of observation are required before an appropriate degree of classification can be made. B.6 When it is suspected that the patient already has aplastic anemia but has been exposed to uniform or relatively uniform continuous or intermittent whole-body external irradiation, and the diagnosis is unclear, a comprehensive analysis and judgment can be made based on the medical history (including past history), irradiation time, estimation of cumulative dose, and chromosome and microcirculation changes.
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