RADIATION ACCIDENTS - PRIMUM-NON-NOCERE

BM toxicity is a major cause of morbidity and mortality after exposure to acute high dose total body radiation. Here, we consider therapeuti c strategies useful in victims of radiation accidents including suppor tive care (antibiotics, protected environments and transfusions), hema topoietic growth factors and BMTs. Selecting the best strategy require s precise knowledge of the details of radiation exposure. This informa tion is rarely available in accidents. An alternative is to assess ris k:benefit ratios for different strategies at approximate radiation dos es. Using this approach, we suggest supportive care be given to all pe rsons at risk of developing BM failure. The favorable risk:benefit rat io of hematopoietic growth factors argues for their use when moderate to severe BM failure is predicted. Transplants, which have the least f avorable risk:benefit ratio, should be used only when there is a subst antial risk of irreversible BM damage.