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Update (10/22): Status of patients from the JCO Criticality
RADSAFERS,
Science and Technology Agency started publishing newsletters to keep the local
public informed. The 10/15 issue can be found at "
http://sta-atm.jst.go.jp/news_letter.html"; It is a image file. Even if you
can't read Japanese, you can see the flowchart and figure out what happened.
"http://www.jca.apc.org/gensuikin/tokai/hibaku_jco.gif"; is table of estimated
external dose and surface contamination level for JCO workers. Column 1: Name
(erased); Column 2: Start of accident; Column 3: Start of count; Column 4:
Elapsed time; Column 5: Na-24 activity as measured by whole body counter in Bq.;
Column 6: Decay corrected Na-24 (Bq); Column 7: Estimated dose [mGy] (neutron +
gamma); and Column 8: Body surface contamination.(all on head, and one bottom of
left shoe)
Notes at the bottom of the table are: "Note 1: Na-24 value of 1Bq = 0.5 - 3 uGy
used (from IAEA Technical Series No. 211)"; "Note 2: Surface measurement limit
40 Bq/cm^2"; "Note 3: Na-24 detection limit 100 Bq."
Hand-written note at the bottom are revealing. "Completed decon of people with
contamination"; "Fraction of neutron is unknown"; "It is difficult to calculate
dose in mSv"; and "Large uncertainty in mGy."
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 level: 99% WBC count: 0/mm^3
Hemoglobin conc.: 9.5 g/dl Platelet count: 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 level: 99% WBC count: 30/mm^3
Hemoglobin conc.: 9.5 g/dl Platelet count: 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 level: 99% WBC count: 20/mm^3
Hemoglobin conc.: 8.8 g/dl Platelet count: 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 level: 98% WBC count: 20/mm^3
Hemoglobin conc.: 8.9 g/dl Platelet count: 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 level: 99% WBC count: 10/mm^3
Hemoglobin conc.: 9.1 g/dl Platelet count: 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 level: 98% WBC count: 0/mm^3
Hemoglobin conc.: 8.7 g/dl Platelet count: 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 level: 99% WBC count: 0/mm^3
Hemoglobin conc.: 7.9 g/dl Platelet count: 44,000/mm^3
CRP: 6.74 mg/dl
10/18/99
Slight improvement in sores in mouth. Providing medication for strong throat
pain. No indication of deterioration of lung function.
BP: 105/59 Pulse: 76/min. Temp (peak): 37.5 C
Blood oxygen level: 98% WBC count: 10/mm^3
Hemoglobin conc.: 8.1 g/dl Platelet count: 24,000/mm^3
CRP: 9.87 mg/dl
10/19/99
Radiation cause pain in lining of mouth showing sign of improvement.
BP: 122/61 Pulse: 78/min. Temp (peak): 38.3 C
Blood oxygen level: 98% WBC count: 30/mm^3
Hemoglobin conc.: 8.4 g/dl Platelet count: 13,000/mm^3
CRP: 10.17 mg/dl
10/20/99
Providing medication for strong throat pain and pain on finger tips. Fever and
inflammation continues. No indication of deterioration of lung function.
BP: 112/72 Pulse: 87/min. Temp (peak): 38.1 C
Blood oxygen level: 98% WBC count: 60/mm^3
Hemoglobin conc.: 8.0 g/dl Platelet count: 41,000/mm^3
CRP: 11.52 mg/dl
10/21/99
Chromosome analysis of bone marrow collected on 10/18 shows presence of cells
from the patient as well cells from the donor co-existing. Continuing strong
throat pain, pain on finger tips and soles of feet. Change in skin tone and
swelling of fingers, and face observed. Fever and inflammation continues. No
indication of deterioration of lung function. Overall conscious and clear, but
showing signs of exhaustion.
BP: 110/66 Pulse: 87/min. Temp (peak): 38.2 C
Blood oxygen level: 98% WBC count: 100/mm^3
Hemoglobin conc.: 8.5 g/dl Platelet count: 26,000/mm^3
CRP: 13.84 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
10/18/99 17:00
No major change since the previous day.
BP: 128/60 mm Hg Pulse: 124/min.
Resp: 18/min. Temp: 38.0 C
Providing sedative and continuing with ventilation. X-ray reveals no major
change in lung, and renal function stable. Area with erythema has more blisters,
but no clear indication of infection. Still requiring RBC and platelet
transfusion. WBC count in small blood vessels increased to 8,300/mm^3.
Chromosome study confirmed that the increase in WBC count is due to transplanted
bone marrow. Temperature is 38.0 C but there is no indication of infection. No
bowel movement.
Treatment Direction: Prevention of transplant rejection, early indication and
treatment. Continue ventilation management, infection prevention, nutrition
management, continued transfusion management, and detailed total body
management.
Others: Vigilance must be maintained.
10/19/99 17:00
No major change since the previous day.
BP: 114/50 mm Hg Pulse: 114/min.
Resp: 20/min. Temp: 38.1 C
Continuing with ventilation. Renal function stable. Blistering in the upper
right thigh area with erythema has increased but no clear indication of
infection. Still requiring RBC and platelet transfusion. WBC count in small
blood vessels increased to 8,200/mm^3. Fever with temperature of 38.0 C but
there is no indication of infection. No bowel movement.
Treatment Direction: Early detection and treatment to prevent of transplant
rejection, . Continue ventilation management, infection prevention, nutrition
management, continued transfusion management, and detailed total body
management.
Others: Vigilance must be maintained.
10/20/99 17:00
No major change since the previous day.
BP: 150/74 mm Hg Pulse: 116/min.
Resp: 20/min. Temp: 38.0 C
Continuing with ventilation. No indication of transplant rejection. No major
change in lung function or in X-ray. Renal function stable. More blistering in
the upper right thigh area with erythema but no clear indication of infection.
Still requiring RBC and platelet transfusion. WBC count in small blood vessels
increased to 7,200/mm^3. Fever with temperature of 38.0 C but there is no
indication of infection. Two diarrhea (bowel movements) but no blood in stool.
Treatment Direction: Early detection and treatment to prevent of transplant
rejection, . Continue ventilation management, infection prevention, nutrition
management, continued transfusion management, and detailed total body
management.
Others: Vigilance must be maintained.
10/21/99 17:00
No major change since the previous day.
BP: 116/52 mm Hg Pulse: 118/min.
Resp: 18/min. Temp: 38.3 C
Continuing with ventilation. No indication of transplant rejection. No major
change in lung function or in X-ray. Renal function improving. More blistering
on
the right arm and is unlike normal thermal burn but no clear indication of
infection.
Still requiring RBC and platelet transfusion. WBC count in small blood vessels
increased to 7,700/mm^3. Fever with temperature of 38.0 C but there is no
indication of infection. No bowel movement.
Treatment Direction: Recommend evaluation of intestinal function. Early
detection and treatment to prevention of transplant rejection, . Continue
ventilation management, infection prevention, nutrition management, continued
transfusion management, and detailed total body management.
Others: Vigilance must be maintained.
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 count: 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 count: 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 count: 58,000/mm^3
WBC count trending down. Platelet count increased due to transfusion.
10/19/99
Stable.
Temp: 36.0 C BP: 115/80
WBC count trending down. In order to prevent infection, it is planned to move
the patient to a sterile isolation room today.
10/20/99
Stable.
Temp: 35.8 C BP: 140/75
WBC and platelet count trending down. In order to prevent infection, the patient
was moved to a sterile isolation room yesterday.
--------------------------------------------------------------------------
Toshihide "Tosh" Ushino, CHP Tel: (800) 548-5100 x2413
Product Development Manager Fax: (714) 668-3149
Dosimetry Div., ICN Biomedicals, Inc. Email: tushino@icnpharm.com
3300 Hyland Ave., Costa Mesa, CA USA 92626 tushino@hotmail.com
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