Radiation accidents: primum non nocere

BM toxicity is a major cause of morbidity and mortality after exposure to acute high dose total body radiation. Here, we consider therapeutic strategies useful in victims of radiation accidents including supportive care (antibiotics, protected environments and transfusions), hematopoietic growth factors and BMTs. Selecting the best strategy requires precise knowledge of the details of radiation exposure. This information is rarely available in accidents. An alternative is to assess risk:benefit ratios for different strategies at approximate radiation doses. Using this approach, we suggest supportive care be given to all persons at risk of developing BM failure. The favorable risk:benefit ratio of hematopoietic growth factors argues for their use when moderate to severe BM failure is predicted. Transplants, which have the least favorable risk:benefit ratio, should be used only when there is a substantial risk of irreversible BM damage.