[Date Prev][Date Next][Thread Prev][Thread Next][Date Index][Thread Index]
Update (10/18): Status of patients from the JCO Criticality Accident
RADSAFERS,
There is at least one good news from Japan regarding the patient (Mr. Ouchi - 17
Sv.) who received borrow marrow transplant. The transplant was apparently
successful. They released summary of his white blood cell counts.
CRP stands for C-Reactive Protein. According to http://medical-dictionary.com/,
"This blood test is used as an indicator of acute inflammation. C-reactive
protein is a protein of the pentraxin family, produced by the liver during
periods of inflammation and detectable in serum in various disease condtions
particularly during acute phase of immune response. Normally C-reactive protein
should be negative in the bloodstream." CRP level of 5 is apparently in normal
range, and >7 being elevated (inflammation >20). Thank you to my friend Penny
Hugenroth for the web page URL, and Mark Hanlon of New Childrens Hospital in
Australia for CRP range.
Tosh Ushino, ICN Dosimetry, tushino@icnpharm.com
************************
RBC = Red Blood Cell WBC = White Blood Cell BP = Blood Pressure
Temp = Temperature Pulse = Pulse Rate Resp = Respiration rate
CRP = C-reactive protein
Masato Shinohara, 39 year old, 10 Sv
-------------------------------------------------
10/09/99
BP: 109/59 Pulse: 78/min. Temp: 36.8 C
Blood oxygen: 99% WBC count: 0/mm^3
Hemoglobin: 9.5 g/dl Platelet: 43,000/mm^3
10/12/99 19:30
Pain in lining of the mouth has increased substantially, but overall condition
is as good as before. No indication of infection. Clear, conscious.
BP: 122/67 Pulse: 67/min. (normal) Temp: 36.5 C
Blood oxygen: 99% WBC count: 30/mm^3
Hemoglobin: 9.5 g/dl Platelet: 29,000/mm^3
10/13/99
Increased pain in lining of the mouth. Overall condition is as good as before.
No indication of infection. Clear, conscious.
BP: 118/63 Pulse: 74/min. (normal) Temp: 36.7 C
Blood oxygen: 99% WBC count: 20/mm^3
Hemoglobin: 8.8 g/dl Platelet: 10,000/mm^3
10/14/99
Reddening of lining of mouth thought to be from radiation damage. Severe pain in
the mouth. Ulceration (edema?) on inside lining of cheeks. No major change to
overall condition. No clear indication of infection. Platelet count increased
due to transfusion.
BP: 119/66 Pulse: 70/min. (normal) Temp: 36.8 C
Blood oxygen: 98% WBC count: 20/mm^3
Hemoglobin: 8.9 g/dl Platelet: 70,000/mm^3
10/15/99
Sore inside mouth has worsened and appearance of fever and inflammation. No
other major change to overall condition.
BP: 114/65 Pulse: 75/min. (normal) Temp: 37.5 C
Blood oxygen: 99% WBC count: 10/mm^3
Hemoglobin: 9.1 g/dl Platelet: 19,000/mm^3
CRP: 5.04 mg/dl
10/16/99
Painful sore inside mouth, fever and inflammation continues. Vomited once. No
other major change to overall condition.
BP: 109/60 Pulse: 73/min. Temp: 37.8 C
Blood oxygen: 98% WBC count: 0/mm^3
Hemoglobin: 8.7 g/dl Platelet: 51,000/mm^3
CRP: 5.68 mg/dl
10/17/99
Patient under considerable pain due to radiation induced sore inside mouth. Due
to worsening fever and inflammation, infection is strongly suspected.
Antibiotics and intravenous feeding provided. No indication of deterioration of
lung function.
BP: 116/63 Pulse: 79/min. Temp (peak): 38.5 C
Blood oxygen: 99% WBC count: 0/mm^3
Hemoglobin: 7.9 g/dl Platelet: 44,000/mm^3
CRP: 6.74 mg/dl
Hisashi Ouchi, 35 years old ? 17 Sv
------------------------------------------------
10/09/99
Due to the effect of sedative, patient is not entirely coherent.
Oxygen intake through lung decreasing.
BP: 136/60 mm Hg Pulse: 104/min.
Resp: 12/min. Temp: 37.5 C
WBC and platelet count continuing to decrease. No indication of infection.
Received good advise from Dr. Gale.
Treatment Direction: Ventilate, take precaution against infection.
Others: Vigilance must be maintained.
10/12/99 19:30
Providing sedative.
BP: 147/72 mm Hg Pulse: 108/min.
Resp: 16/min. Temp: 36.9 C
Continuing with ventilation. Since the previous day, providing hormone to assist
in tissue regeneration to repair lung impediment, chest X-rays reveal slight
improvement and there is improved oxygen intake through lungs. Continued
transfusion of RBCs and platelets is required. There is concern for
complications due to infection, but thus far there is no sign of infection. No
bowel movement or blood in stool.
Treatment Direction: Continue with ventilation, prevent infection, nutritional
management, and transfusion.
Others: Fever and inflammation maybe masked by tissue regeneration hormone.
Vigilance must be maintained.
10/13/99 17:00
Providing sedative.
BP: 139/72 mm Hg Pulse: 103/min.
Resp: 19/min. Temp: 36.7 C
Continuing with ventilator. Decrease in renal function, possibly result of
medication. Some bleeding from lining of mouth and stomach.
Continued transfusion of RBCs and platelets is required.
There is concern for complications due to infection, but thus far there is no
sign of infection. No bowel movement or blood in stool.
Treatment Direction: Continue with ventilation, prevent infection, nutritional
management, and transfusion.
Others: Fever and inflammation maybe masked by tissue regeneration hormone.
Vigilance must be maintained.
10/14/99 17:00
No major change since the previous day. Providing sedative.
BP: 138/70 mm Hg Pulse: 106/min.
Resp: 19/min. Temp: 37.3 C
Continuing with ventilation management. Diminished renal function. Some bleeding
from lining of mouth. Continued transfusion of RBCs and platelets is required.
There is concern for complications due to infection, but thus far there is no
sign of infection. No bowel movement or blood in stool.
Treatment Direction: Continue with ventilation, prevent infection, nutritional
management, and transfusion.
Others: Vigilance must be maintained.
10/15/99 17:00
No major change since the previous day. Providing sedative.
BP: 158/76 mm Hg Pulse: 114/min.
Resp: 13/min. Temp: 38.1 C
Continuing with ventilation. Oxygen intake is good. Renal function stable. Some
bleeding from lining of mouth. Requiring transfusion of RBCs and platelets.
Concern for complication from infection but thus far no indication of infection.
Epilation observed. There was a bowel movement.
Treatment Direction: Evaluating feasibility of ?direct feeding method to
intestine?(?). Ventilation management, infection prevention, nutrition
management, continued transfusion management, and detailed total body
management.
Others: Vigilance must be maintained.
10/16/99 17:00
Providing sedative.
BP: 133/64 mm Hg Pulse: 114/min.
Resp: 24/min. Temp: 38.2 C
Continuing with ventilation. Renal function showing some improvement. Requiring
transfusion of RBCs and platelets. WBC count has increased. Performing
evaluation to determine if borrow marrow transplant was successful. Appearance
of radiation burn changed. The color is dark red, and blisters appearing in
upper right thigh. It is unclear if there is infection. No bowel movement.
Treatment Direction: Will evaluate the trend of WBC to determine if bone marrow
was successful. Still evaluating feasibility of ?direct feeding method to
intestine.? Continue ventilation management, infection prevention, nutrition
management, continued transfusion management, and detailed total body
management.
Others: Vigilance must be maintained.
10/17/99 17:00
BP: 130/58 mm Hg Pulse: 120/min.
Resp: 12/min. Temp: 37.8 C
Providing sedative and continuing with ventilation. X-ray reveals increase in
lung damage, but oxygen intake is satisfactory. Renal function stable. Rate of
RBC and platelet decrease has eased. WBC count had increased rapidly, confirming
the success of bone barrow transplant. It is still unclear if there is
infection. There was diarrhea but no blood in stool.
Treatment Direction: Will evaluate the trend of WBC to determine if bone marrow
was successful. Still evaluating feasibility of ?direct feeding method to
intestine.? Continue ventilation management, infection prevention, nutrition
management, continued transfusion management, and detailed total body
management.
Others: Vigilance must be maintained.
WBC Count Trend
============================
10/06 600/mm^3 1st transplant
10/07 100 2nd transplant
10/11 0
10/15 16:00 300
10/16 00:00 600
06:00 1000
16:00 2000
10/17 06:00 4800
Yutaka Yokokawa, 54-years old - 3 Sv
-----------------------------------------------
10/09/99
Stable.
Temp: 35.9 C BP: 110/70
WBC and lymphocyte count remain stable.
10/10/99
Stable.
Temp: 35.5 C BP: 115/70
WBC and lymphocyte count remain stable.
10/11/99
Stable.
Temp: 36.0 C BP: 120/80
WBC and lymphocyte count remain stable.
10/12/99
stable.
Temp: 36.1 C BP: 115/90
WBC and lymphocyte count remain stable.
10/14/99
Stable, conscious, clear.
Temp: 36.0 C BP: 110/80
WBC and lymphocyte count decreasing.
10/15/99
Stable.
Temp: 35.6 C BP: 115/75
WBC and platelet count decreasing.
Borrow marrow will be examined to assess recovery.
10/16/99
Stable.
Temp: 35.8 C BP: 130/90
WBC: 4100/mm^3 Platelet: 42,000/mm^3
WBC and platelet count trending down.
10/17/99
Stable.
Temp: 36.0 C BP: 130/75
WBC: 3000/mm^3 Platelet: 33,000/mm^3
WBC and platelet count trending down.
Platelet transfusion.
10/18/99
Stable.
Temp: 36.2 C BP: 120/82
WBC: 2400/mm^3 Platelet: 58,000/mm^3
WBC count trending down. Platelet count increased due to transfusion.
************************************************************************
The RADSAFE Frequently Asked Questions list, archives and subscription
information can be accessed at http://www.ehs.uiuc.edu/~rad/radsafe.html