GB 16388-1996 Diagnostic criteria and treatment principles 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 applies to occupational radiation workers who are exposed to continuous or intermittent high-dose external radiation for a long time under accidental exposure. GB 16388-1996 Diagnostic criteria and treatment principles for subacute radiation sickness caused by external exposure GB16388-1996 standard download decompression password: www.bzxz.net

National Standard of the People's Republic of China
Subacute radiation sickness from external exposure
Diagnostic criteria and principles of managementfor subacute radiation sickness from external exposureGB16388—1996
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 it is not accompanied by asthenic neurasthenia syndrome. Clinically, it is mainly characterized by hematopoietic dysfunction. It is divided into mild and severe degrees according to symptoms and the degree of hematopoietic damage. 1 Subject content and scope of application
This standard specifies the diagnostic criteria and management principles for subacute radiation sickness from external exposure. This standard is applicable to occupational radiation workers who have been exposed to continuous or intermittent high-dose external radiation for a long period of time under accidental irradiation. Non-radiation workers who are accidentally exposed to radiation and develop subacute radiation sickness can also be diagnosed and treated according to this standard. If radiation workers or non-radiation workers are indeed exposed to radiation on duty and develop this disease, 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, and combine with the comprehensive analysis of health records to exclude other diseases.
3 Diagnostic criteria
3.1 Continuous or intermittent cumulative external irradiation greater than 1 Gy uniform whole-body dose for a long period of time (several weeks to several 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 there is hyperplasia, 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 drug treatment is ineffective.
3.7 The following examination abnormalities may be accompanied:
Microcirculation disorder:
Immune dysfunction,
Coagulation disorder;
Reproductive dysfunction.
4 Grading standard
Approved by the State Administration of Technical Supervision on May 23, 1996 358
Implemented on December 1, 1996
GB 16388—1996
4.1.1 Slow onset. Anemia, infection, and bleeding are relatively mild. The blood picture declines slowly, and the bone marrow has a certain degree of damage. 4.1.2 Blood picture: Hemoglobin is 120 g/L for males and 100 g/L for females, white blood cell count <4×10°/L, and platelet count <80X×10°/L. In the early stage, only 1 to 2 of these abnormalities may appear. 4.1.3 Bone marrow picture: Two or three lines of the bone marrow granulocyte, erythrocyte, and megakaryocyte systems are reduced, at least one part is poorly proliferative, and megakaryocytes are significantly reduced. 4.1.4 After being out of the radiation and adequately treated, recovery is expected. 4.2 Severe
4.2.1 The onset is relatively rapid, and anemia is progressively aggravated, often accompanied by infection and bleeding. 4.2.2 Blood picture: Hemoglobin <80g/L, reticulocytes <1%, white blood cells <1.0×10°/L, absolute value of neutrophils <0.5×10°/L, and platelets <20×10/L.
4.2.3 Bone marrow: decreased proliferation in multiple parts, significant decrease in granulocyte, erythroid and megakaryocyte hematopoietic cells, if active proliferation, lymphocyte increase is required. 4.2.4 After being away from radiation and adequate treatment, recovery is slow, or the condition cannot be prevented from worsening, and there is a possibility of transformation into myelodysplastic syndrome or leukemia, with a poor prognosis.
5 Treatment principles
Apply the following principles according to the severity of the disease and clinical characteristics. 5.1 Avoid radiation exposure, and prohibit the use of drugs that are not conducive to hematopoiesis. 5.2 Protect and promote the recovery of hematopoietic function, and can combine male hormones or protein anabolic hormones with drugs that improve microcirculation function, such as 654-2.
5.3 Correct anemia, supplement various blood formed elements to prevent and treat complications caused by hematopoietic dysfunction. 5.4 Enhance the body's resistance, intramuscular injection of immunoglobulin, and for severe cases with low immune function, intravenous infusion of fetal liver cell suspension, immunoglobulin, or application of immune enhancers.
5.5 When the white blood cell count is <1.0×10°/L, implement protective isolation. 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 sub-healing radiation sickness
After the condition stabilizes, conduct strict medical follow-up observation and regular health examinations. Pay attention to possible long-term effects and make corresponding treatments. According to the recovery situation, you can recuperate, rest or arrange appropriate non-radioactive work. For those who are not fully recovered and affect their ability to live or work, the disability level will be assessed according to relevant national regulations and enjoy corresponding treatment. 359
A1 Microcirculation (micro-circulation) GB16388-1996
Appendix A
Explanation of terms
(Supplement)
Microcirculation is the circulation dynamics of body fluids (blood, tissue fluid, lymph) that directly participate in material exchange. The microcirculation that can be directly observed clinically is limited to the blood circulation part. Commonly used sites for observing microcirculation status include nail folds, conjunctiva, fundus, etc. A2 Myelodysplastic syndrome (MDS) is a group of diseases characterized by abnormalities in the quality and quantity of tri-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), chronic myelomonocytic leukemia (CMML), and refractory anemia with excess blasts in transformation. Appendix B
Instructions for the correct use of this standard
(reference)
B1 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 type. 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.
B2 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, palpitations and shortness of breath, difficulty falling asleep, frequent dreams and easy awakening, forgetfulness, and sexual dysfunction. In addition to symptoms related to pancytopenia such as fatigue, dizziness, and palpitations, the above symptoms are rare in subacute radiation patients, which is different from external irradiation chronic radiation sickness with asthenic neurasthenia syndrome as the main clinical manifestation. B3 Microcirculatory disorder: 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. B4 In the chromosome examination of this type of patients, both unstable aberrations induced by recent irradiation and stable aberrations remaining from early irradiation can be seen. This feature is different from the patients with external irradiation acute radiation sickness who are mainly characterized by unstable aberrations. This is different from primary aplastic anemia, where chromosomal aberrations are not obvious or absent. B5 Regarding the grading issue: This type of radiation sickness is divided into mild and severe grades according to the diagnostic criteria for aplastic anemia. However, in actual work, some patients may have some indicators that meet the severe criteria and some indicators that meet the mild criteria. In this case, a comprehensive analysis and even a long period of observation are required before an appropriate grading can be made.
B6 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), exposure time, cumulative dose estimation, and chromosome and microcirculation changes.
Additional notes: www.bzxz.net
This standard was proposed by the Ministry of Health of the People's Republic of China. This standard was drafted by the 307th Hospital affiliated to the Academy of Military Medical Sciences. The main drafters of this standard were Jiang Benrong and Ye Genyao. This standard is interpreted by the Ministry of Health's Industrial Hygiene Laboratory, the technical unit entrusted by the Ministry of Health. 360
Tip: This standard content only shows part of the intercepted content of the complete standard. If you need the complete standard, please go to the top to download the complete standard document for free.