| Suggested Treatment | Treatment Detail |
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Reassurance |
- Make sure there is follow up mental health support for individual concerns over the following weeks whether or not there are other medical issues. (See also Provide Follow-up Instructions)
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Seek more information |
- Serial CBCs/platelets
- Systemic evaluation
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If blood product support, irradiated, leuko-reduced |
- Transfuse red cells to maintain a Hgb of > 8 gm.
- Keep platelet count > 10K (both parameters are for patients in steady state).
- If patients are bleeding, treat the underlying bleeding and the patient may require higher parameters based on clinical factors.
- See also Use of Blood Products
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Cytokines/Growth factors |
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HLA type patient |
- For patients in the moderate, severe or very severe with survivable exposure and limited other comorbidities or trauma, send blood for HLA typing to local or central laboratory.
- If blood counts are too low, may send buccal swab for HLA analysis.
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Consider PICC line |
- For patients expected to become neutropenic, consider placing a central line for transfusions, antibiotics, etc...
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Search for donors |
- Once HLA is obtained, search for donors through the National Marrow Donor Program.
- Obtain consultation from stem cell transplant physician to facilitate the potential for stem cell transplantation.
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Reverse isolation |
- Consider reverse isolation for patients with moderate, severe or very severe radiation exposure, especially if there are concomitant other injuries that would place the patient at high risk of systemic infections.
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Start fluconazole as prophylactic when neutropenic 1 |
- Initial dose of 200 mg daily
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Consider acyclovir if herpes simplex virus positive |
- Acyclovir at 400 mg three times daily
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Consider fluoroquinolone for next prophylaxis |
- based on local hospital known flora, for example ciprofloxacin at 750 mg twice daily.
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Consider prophylactic antibiotic coverage for skin flora if burns are present |
- especially anaerobic coverage using a broad spectrum antibiotics such as piperacillin/tazobactam, imipenim again depending on local hospital flora.
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Consider stem cell transplantation by 2 weeks if donor is identified and available |
- For patients with severe to very severe radiation exposure without other life threatening injuries, early stem cell transplantation should be considered given that autologous hematopoietic recovery will not occur or be extremely delayed.
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Time surgery appropriately |
- If major surgery is required, there is a window of only up to 48 hours after the whole-body exposure, before blood counts will drop.
- Rate of drop will dedicate when surgery can no longer be performed and must wait until blood counts adequately recover.
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