Chemical Agents of Opportunity for Terrorism: TICs & TIMs

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Chemical Agents of Opportunity for Terrorism Training Support Package Participant Guide Slide 27 Dosimetry is a method to gauge the severity of radiation exposure. Based on the specific syndrome that develops, the clinician and health physicist can determine the dose range to which a patient was exposed. In general, the higher the dose, the greater the severity of early effects and the greater the possibility of life threatening effects. Each of these syndromes represents an increasing exposure to radiation and carries a greater risk of adverse or fatal outcomes. We will discuss a few of them in more detail. 1. Subclinical – while tissue damage may occur, no overt symptoms are expected and the body should be able to repair damage that has been done. 2. Hematopoietic syndrome - characterized by bone marrow dysfunction with decreased lymphocyte, polymorphonuclear (PMN) white blood cells, and platelets, resulting in immunodeficiency, increased infectious complications, bleeding, anemia, and impaired wound healing. 3. Cutaneous (Skin) syndrome - can occur with other syndromes; characterized by loss of epidermis (and possibly dermis) with "radiation burns." 4. Gastrointestinal syndrome - characterized by loss of cells lining intestinal crypts and loss of mucosal barrier, with alterations in intestinal motility, fluid and electrolyte loss with vomiting and diarrhea, loss of normal intestinal bacteria, sepsis, and damage to the intestinal microcirculation, along with the hematopoietic syndrome. 5. Cerebrovascular/Central Nervous System (CNS) syndrome - primarily associated with effects on the vasculature and resultant fluid shifts. Signs and symptoms include vomiting and diarrhea within minutes of exposure, confusion, disorientation, cerebral edema, hypotension, and hyperpyrexia. Requires massive exposure and is fatal in short time. December 2008 Version 2.0 Page 390
Chemical Agents of Opportunity for Terrorism Training Support Package Participant Guide Slide 28 The hematopoietic syndrome (Bone marrow syndrome) will usually predominate with a dose between 1 and 5 Gy (100 – 500 rads) though mild symptoms may occur as low as 0.3 Gy or 30 rads. Irradiation of the bone marrow results in a fall in lymphocytes, although some of the early fall in lymphocyte count (the first 2 days) is related to migration of lymphocytes out of the bloodstream in response to tissue injury. The degree and rate of fall serve as markers for the extent of exposure. Serial measurement of the lymphocyte count can be used prognostically. The survival rate of patients with this syndrome decreases with increasing dose. The primary cause of death is infection (no white blood cells) and hemorrhage (no platelets). December 2008 Version 2.0 Page 391
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Chemical Agents of Opportunity for Terrorism: TICs & TIMs

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