Radiation Emergencies: Evaluation, Management, and Transplantation

Radiation or marrow toxic emergencies can lead to severe pancytopenia along with other multiorgan injury. Experience in managing severe myelosuppression suggests that hematology, oncology and transplantation physicians should participate in preparedness planning for such events. Evaluation and management of marrow injured patients requires their expertise. Understanding of the biology of radiation injury, clinical dosimetry to estimate exposure and defined elements of supportive care are essential for appropriate emergency and follow-up treatment. Some patients with expected radiation exposure >4Gy may have extended myelosuppression and be candidates for consideration of allogeneic hematopoietic stem cell transplantation (HSCT). Issues related to patient screening, supportive care, and planning for transplantation are best addressed ahead of time to enable readily available information and guidelines for patient management. National and international contingency planning for such urgencies is underway as effective emergency mobilization requires forethought, education, and pre-established protocols for treatment. Radiation and marrow toxic emergencies may seem unlikely, but the best approach to appropriate medical support is preparedness, contingency planning, and planned research to improve guidelines for the future.