ИСХОД ХРОНИЧЕСКОЙ ЛУЧЕВОЙ БОЛЕЗНИ ПОДОСТРОГО ТЕЧЕНИЯ В ГИПОПЛАСТИЧЕСКУЮ АНЕМИЮ

Abstract

Purpose: A retrospective analysis of the clinical observation of chronic radiation sickness (CRS) culminating in the development of aplastic anemia. Material and methods: The object of the examination was the medical history of a 25-year-old man, an apparatchik at the Mayak Production Association, who worked under conditions of external exposure and internal intake of radionuclides from July 1948 to December 1949. Results: When he was employed, he was practically healthy. During the work, according to the data of individual dosimetric control, he received external relatively uniform exposure in a total dose of 1.72 Gy. During the entire observation period (2 years 4 months) in the 2nd therapeutic department of the Medical Unit No. 71 (from 12/15/49 to 01/15/52) and then in a special clinic of the IBP of the Ministry of Health of the USSR (from 01/17/52 to 03/24/52). It was noted the excretion of radioactive substances in the daily urine 8.3‒28.3 Bq, in the feces – 13.3–1133.3 Bq, without a decrease in their number in subsequent studies. Sick since August 1949. Taking into account the professional history, the presence of sepsis, severe hemorrhagic syndrome, complete aplasia of the bone marrow, long-term carriage and release of radioactive substances, in 1952 the final clinical diagnosis was formulated: Chronic recurrent form of radiation injury due to ingestion of radioactive substances, in a state of exacerbation. Aplastic anemia. Septicopyemia. General hemorrhagic syndrome. Parenchymal changes in internal organs. Meningoencephalitis. Myocarditis. Left-sided pneumonia with pleurisy. Residual effects of subarachnoid hemorrhage. Trophic ulcers of the left buttock. Pyoderma with necrosis of both elbows. Infiltration of the upper third of the right thigh along the back surface. On March 24, 1952, the patient died. The clinical diagnosis fully coincided with the pathoanatomical diagnosis. Conclusion: The case history of patient E. is a vivid illustration of the subacute course of CRS with a rapid lethal outcome. The presence of a significant internal intake of osteotropic radionuclides led to the predominance of destructive processes in the bone marrow over regenerative ones and, accordingly, predetermined the development of aplastic anemia with a fatal outcome.