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Update (11/01): Status of patients from the JCO Criticality
RADSAFERS,
Since these updates are getting quite lengthy, I'll restrict the updates to the
most recent seven days (and that still may be too lengthy).
Tosh Ushino
ICN Dosimetry
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RBC = Red Blood Cell WBC = White Blood Cell BP = Blood Pressure
Temp = Temperature Pulse = Pulse Rate Resp = Respiration rate
CRP = C-reactive protein
Mr. A: 17 Sv
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10/25/99 17:00
No major change since the previous day.
BP: 136/72 mm Hg Pulse: 136/min.
Resp: 20/min. Temp: 37.5 C
Continuing with sedative and ventilation. No major change in lung function.
Various types of medicine used in varying quantities to control degradation of
kidney. Management of radiation burn on anterior upper torso surface including
face, neck and upper thigh has become a major problem. In particular, radiation
burn on the right thigh area thought to have received the highest radiation
requires careful observation. Still requiring platelet transfusion, however
there has not been RBC transfusion past 2 days. WBC count in small blood vessels
is 12,500/mm^3. Three bowel movements with green stool. No indication of
transplant rejection.
Treatment Direction: Prevention of infection of radiation. 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.
10/26/99 17:00
No major change since the previous day.
BP: 112/62 mm Hg Pulse: 122/min.
Resp: 14/min. Temp: 36.2 C
Continuing with sedative and ventilation. No major change in lung or renal
function. Damage to skin and lining (membrane?) of area thought to have received
highest dose has become major problem. Still requiring platelet transfusion,
however RBC production appears to be recovering. WBC count in small blood
vessels is 8,900/mm^3. Three bowel movements with green stool. No indication of
transplant rejection.
Treatment Direction: Prevention of infection of areas with radiation burn. 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: Continue vigilance.
10/27/99 17:00
BP: 143/76 mm Hg Pulse: 132/min.
Resp: 22/min. Temp: 37.5 C
Continuing with sedative and ventilation. Damage to skin and mucous membrane of
area thought to have received highest dose has become major problem. No major
change to lung function and damaged kidney function. Still requiring platelet
transfusion, however blood production appears to be recovering. WBC count in
small blood vessels is 8,000/mm^3. Green stool in diarrhea totaling 815 gram
(midnight to 3:00 PM). Treatment was initiated since we cannot rule out the
possibility that this diarrhea is indication of transplant rejection. But we
also cannot determine if this result of damage to intestine. As before, no clear
indication of infection.
Treatment Direction: Prevention of infection of areas with radiation burn.
Treatment will continue for suspected transplant rejection. Continue ventilation
management, infection prevention, nutrition management, continued transfusion
management, and detailed total body management.
Others: Continue vigilance.
10/28/99 17:00
BP: 110/71 mm Hg Pulse: 122/min.
Resp: 15/min. Temp: 37.1 C
Continuing with sedative and ventilation.
Diarrhea from intestinal damage thought be caused by radiation has become a big
problem. Today from midnight to 3:00 PM there was total of 1,240 gram of stool
in diarrhea. Damage to skin and mucous membrane of area thought to have received
highest dose has become worse. Kidney function worsening and we are trying to
find the cause. No major change to lung function. Still requiring platelet
transfusion, however blood production appears to be recovering. WBC count in
small blood vessels is 8,200/mm^3. Continuing treatment of graft-versus-host
disease. As before, no clear indication of infection.
Treatment Direction: Prevention of infection of areas with radiation burn.
Treatment will continue for graft-versus-host disease. Determine the cause of
kidney deterioration Continue ventilation management, infection prevention,
nutrition management, continued transfusion management, and detailed total body
management.
Others: Continue vigilance.
10/29/99 17:00
BP: 132/64 mm Hg Pulse: 100/min.
Resp: 15/min. Temp: 38.2 C
Continuing with sedative and ventilation. No major change to respiratory
function. Kidney function worsening but still does not require dialysis. Damage
to skin and mucous membrane of area thought to have received highest dose has
become a major problem. In particular, condition on right forearm and left hand
is severe. Still requiring platelet transfusion, however blood production
appears to be recovering. WBC count in small blood vessels is 9,600/mm^3. There
was total of 1,755 gram of stool in diarrhea (from midnight to 4:00 PM ). Since
we cannot rule out the possibility that this diarrhea is indication of
transplant rejection we are continuing treatment. But we also cannot determine
if this result of damage to large intestine. As before, no clear indication of
infection.
Treatment Direction: Prevention of infection of areas with radiation burn.
Treatment will continue for suspected graft-versus-host disease. Continue
ventilation management, infection prevention, nutrition management, continued
transfusion management, and detailed total body management.
Others: Continue vigilance.
10/30/99 17:00
BP: 126/72 mm Hg Pulse: 120/min.
Resp: 16/min. Temp: 37.4 C
Continuing with sedative and ventilation. No major change to respiratory
function. Kidney function improving. Damage to skin and mucous membrane of area
thought to have received highest dose has become a major problem. Affected area
expanded to back on right side. In particular, condition on right forearm and
left hand is severe. Still requiring platelet transfusion, however blood
production appears to be recovering. WBC count in small blood vessels is
12,700/mm^3. Diarrhea continuing but the quantity decreasing (615 gram from
midnight to 4:00 PM ). Since we cannot rule out the possibility that this
diarrhea is indication of transplant rejection we are continuing treatment. But
we also cannot determine if this result of damage to large intestine. As before,
no clear indication of infection.
Treatment Direction: Prevention of infection of areas with radiation burn.
Treatment will continue for suspected graft-versus-host disease. Continue
ventilation management, infection prevention, nutrition management, continued
transfusion management, and detailed total body management.
Others: Continue vigilance.
10/31/99 17:00
BP: 148/76 mm Hg Pulse: 118/min.
Resp: 24/min. Temp: 36.7 C
Continuing with sedative and ventilation. No major change to respiratory
function. No major change to kidney function, but the highly unusual condition
resulting from radiation burn persists, and perhaps as result of medication,
nutritional uptake is not sufficient and high level of nitrogen found in blood
stream. WBC count in small blood vessels is 17,000/mm^3. Damage to skin and
mucous membrane of area thought to have received highest dose has become a major
problem. Affected area has expanded and severity changing. In particular,
condition on both hands is severe. Diarrhea continuing but the quantity
decreasing (571 gram from midnight to 4:00 PM ). As before, no clear indication
of infection.
Treatment Direction: Prevention of infection of areas with radiation burn.
Treatment will continue for suspected graft-versus-host disease. Continue
ventilation management, infection prevention, nutrition management, continued
transfusion management, and detailed total body management.
Others: Continue vigilance.
11/01/99 17:00
BP: 136/70 mm Hg Pulse: 124/min.
Resp: 20/min. Temp: 38.1 C
Continuing with sedative and ventilation. No major change to respiratory
function. No major change to kidney function, but the highly unusual condition
resulting from radiation burn persists, and perhaps as result of medication,
nutritional uptake is not sufficient and high level of nitrogen found in blood
stream. WBC count in small blood vessels is 16,200/mm^3. Damage to skin and
mucous membrane of area thought to have received highest dose has become a major
problem. Affected area has expanded and severity is changing. In particular,
condition on both hands is severe. Quantity of stool in diarrhea increased
(1,185 gram from midnight to 4:00 PM ). As before, no clear indication of
infection.
Treatment Direction: Prevention of infection of areas with radiation burn.
Treatment will continue for suspected graft-versus-host disease. Continue
ventilation management, infection prevention, nutrition management, continued
transfusion management, and detailed total body management.
Others: Continue vigilance.
Mr. B: 10 Sv
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10/25/99
WBC count has increased to 1550/mm^3, indicating recovery of bone marrow.
Improvement in mouth and throat pain, but numbness in finger tips and soles of
feet accompanied by stabbing pain still increasing. Change to skin and swelling
of face worsening. Fever continues. No indication of deterioration of lung
function. Clear, conscious but appears to be exhausted due to fever.
BP: 135/82 Pulse: 98/min. Temp (peak): 39.2 C
Blood oxygen level: 98% WBC count: 1550/mm^3
Hemoglobin conc.: 8.1 g/dl Platelet count: 29,000/mm^3
CRP: 9.96 mg/dl
10/26/99
WBC count continuing to increase. Skin change and swelling of face continues.
Blistering of skin from fingers to wrist. Fever continues. No indication of
deterioration of lung function.
BP: 140/62 Pulse: 100/min. Temp (peak): 39.5 C
Blood oxygen level: 98% WBC count: 2400/mm^3
Hemoglobin conc.: 7.8 g/dl Platelet count: 38,000/mm^3
CRP: 11.31 mg/dl
10/27/99
Today, WBC count increased to 4,040/mm^3 and lymphocyte increased to 121/mm^3,
indicating further recovery. Bone marrow and blood tests confirmed that it is
chimera consisting of transplanted umbilical cord blood cell and his own stem
cells. Improvement in mouth and throat pain. Much skin change on fingers and
soles of feet, blisters spreading. Worsening skin change to face. Fever at 39 C
level, increase in CRP. Increasing antibiotics. Clear, conscious.
BP: 108/62 Pulse: 97/min. Temp (peak): 39.5 C
Blood oxygen level: 98% WBC count: 4,040/mm^3
Hemoglobin conc.: 8.4 g/dl Platelet count: 22,000/mm^3
CRP: 14.14 mg/dl
10/28/99
Continued improvement in mouth and throat pain, and have resumed oral liquid
diet. Intense skin change on fingers and soles of feet, blisters spreading.
Worsening skin change to face. Fever still at 39 C level, increase in CRP.
BP: 120/70 Pulse: 102/min. Temp (peak): 39.1 C
Blood oxygen level: 97% WBC count: 5,410/mm^3
Hemoglobin conc.: 8.0 g/dl Platelet count: 34,000/mm^3
CRP: 13.3 mg/dl
10/29/99
Pain in mouth and throat nearly gone. Intense skin change on fingers and soles
of feet, blisters spreading. Worsening skin change to face. Fever and CRP still
high.
BP: 134/72 Pulse: 104/min. Temp (peak): 38.8 C
Blood oxygen level: 98% WBC count: 7,700/mm^3
Hemoglobin conc.: 9.0 g/dl Platelet count: 24,000/mm^3
CRP: 15.0 mg/dl
10/30/99
No significant change.
Temp (peak): 37.5 C
WBC count: 10,800/mm^3
10/31/99
No significant change. Lower temperature. Conscious, lucid.
BP: 134/72 Pulse: 88/min. Temp (peak): 37.4 C
Blood oxygen level: 98% WBC count: 14,600/mm^3
Hemoglobin conc.: 9.0 g/dl Platelet count: 24,000/mm^3
CRP: 5.77 mg/dl
11/01/99
No significant change. Lower temperature. Conscious, lucid.
BP: 120/65 Pulse: 89/min. Temp (peak): 37.4 C
Blood oxygen level: 99% WBC count: 16,950/mm^3
CRP: 6.43 mg/dl
Mr. C: 3 Sv
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No recent updates
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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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