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	You are here: Home > Exposure: Diagnose/Manage Acute Radiation Syndrome > Hematopoietic Subsyndrome of Acute Radiation Syndrome (ARS)		Help on REMM New Users: Where Do I Start? What's New on REMM? (12/2012) Multimedia Library Tools Download REMM (12/2012) Download Mobile REMM (12/2012) Dictionary Emergency Contacts Dose Estimator for Exposure Scarce Resources Triage Tool Manage ARS Subsyndromes Print Algorithms & Tables Diagnosis & Treatment Patient Management Algorithms Acute Radiation Syndrome (ARS) Hematopoietic Subsyndrome Cutaneous Radiation Syndrome Time/Dose Effects in ARS Time Phases of ARS Isotopes of Interest Countermeasures: Internal Contamination Countermeasures: Exposure Decontamination Procedures Strategic National Stockpile    Population Monitoring and Radionuclide Decorporation Following a Radiological or Nuclear Incident (NCRP Report No. 166, 2011) Nuclear Detonation Scarce Resources Working Group Publications, 3/2011 (HHS/ASPR) Response to a Nuclear Detonation: State and Local Medical Planners Playbook, 3/2011 (HHS/ASPR) Responding to a Radiological or Nuclear Terrorism Incident: A Guide for Decision Makers (NCRP Report No. 165, 2010) Management of Persons Contaminated With Radionuclides: Handbook (NCRP Report No. 161, Vol. I, 2008) Planning Guidance for Response to a Nuclear Detonation, 2nd Ed, 6/2010 (National Security Staff)    AFRRI AHRQ CDC CRCPD DHS DOE EPA FDA HHS HPS IAEA   ICRP NACCHO NARR NCRP NRC OSHA REAC/TS RERF RITN UNSCEAR WHO
	Hematopoietic Subsyndrome of Acute Radiation Syndrome (ARS) What is ARS? What is exposure? Estimate dose from exposure Perform targeted physical exam Consider these tools for clinical diagnosis and treatment Special issues Multimedia resources References What is ARS? Dictionary definition Hematologic subsyndrome is one of the 4 subsyndromes of ARS top of page What is exposure? Animated illustrations top of page Estimate dose from exposure Dose Estimator (Biodosimetry Tools) — Tools for estimating dose ; video Explaining Biodosimetry - Frequently asked questions Dose Reconstruction - Location, duration, shielding top of page Perform targeted physical exam Targeted physical exam top of page Consider these tools for clinical diagnosis and treatment REMM clinical algorithm for exposure ; video Other radiation injury management algorithms Tool for managing the hematopoietic subsyndrome of ARS Growth factors/white cell cytokines Hematopoietic stem cell transplant Template for adult/pediatric orders after a radiation incident Expert consultation from the Radiation Injury Treatment Network (RITN) Manage ARS with scarce resources after and IND detonation; video top of page Special issues Use of Blood Products - guidelines and warnings Burns and radiation exposure: combined injury Trauma and radiation exposure: combined injury Timing of surgery Multi-organ dysfunction syndrome Management of febrile neutropenia Hematopoietic stem cell transplantation top of page Multimedia resources Radiation effects on blood counts Lymphocyte depletion kinetics graph (Andrews) Radiation effects on blood counts (Verobiev) Radiation effects on blood counts (Fliedner) Time/dose effects in ARS; video Time phases of ARS; video top of page References General references Dainiak N, Gent RN, et al. First Global Consensus for Evidence-Based Management of the Hematopoietic Syndrome Resulting From Exposure to Ionizing Radiation. Disaster Med Public Health Prep. 2011 Oct;5(3):202-212. [PubMed Citation] Waselenko JK, MacVittie TJ, Blakely WF, Pesik N, Wiley AL, Dickerson WE, Tsu H, Confer DL, Coleman CN, Seed T, Lowry P, Armitage JO, Dainiak N; Strategic National Stockpile Radiation Working Group. Medical management of the acute radiation syndrome: recommendations of the Strategic National Stockpile Radiation Working Group. Annals of Internal Medicine 2004; Vol. 140:1037-51. [PubMed Citation] Dainiak N, Ricks RC. The evolving role of haematopoietic cell transplantation in radiation injury: potentials and limitations. BJR Suppl. 2005; 27:169-74. [PubMed Citation] Weisdorf D, Chao N, Waselenko JK, Dainiak N, Armitage JO, McNiece I, Confer D. Acute radiation injury: contingency planning for triage, supportive care, and transplantation. Biol Blood Marrow Transplant. 2006 Jun;12(6):672-82. [PubMed Citation] Copelan EA. Hematopoietic stem-cell transplantation. N Engl J Med. 2006 Apr 27; 354(17):1813-26. [PubMed Citation] Dainiak N, Waselenko JK, Armitage JO, MacVittie TJ, Farese AM. The hematologist and radiation casualties. Hematology Am Soc Hematol Educ Program. 2003;:473-96. [PubMed Citation] Fliedner TM. Nuclear terrorism: the role of hematology in coping with its health consequences. Curr Opin Hematol. 2006 Nov;13(6):436-44. [PubMed Citation] Radiation Injury Treatment Network Acute Radiation Syndrome Treatment Guidelines (PDF - 1.26 MB) (Radiation Injury Treatment Network, September 2010) Weisdorf D, Apperley J, Courmelon P, Gorin NC, Wingard J, Chao N. Radiation Emergencies: Evaluation, Management, and Transplantation. Biol Blood Marrow Transplant. 2007;13:103-6. (PDF - 82 KB) Use of growth factors/white cell (myeloid) cytokines Dainiak N, Gent RN, et al. First Global Consensus for Evidence-Based Management of the Hematopoietic Syndrome Resulting From Exposure to Ionizing Radiation. Disaster Med Public Health Prep. 2011 Oct;5(3):202-212. [PubMed Citation] Herodin F, Drouet M. Myeloprotection following cytotoxic damage: the sooner the better. Exp Hematol. 2008 Jul;36(7):769-70. [PubMed Citation] Dainiak N. Rationale and recommendations for treatment of radiation injury with cytokines. Health Phys. 2010 Jun;98(6):838-42. [PubMed Citation] Drouet M, Herodin F. Radiation victim management and the haematologist in the future: time to revisit therapeutic guidelines? Int J Radiat Biol. 2010 Aug;86(8):636-48. Review. [PubMed Citation] Myeloid Growth Factors, Journal of the National Comprehensive Cancer Network, 2009 Jan; 7(1). (Registration required) Herbst C, Naumann F, Kruse EB, Monsef I, Bohlius J, Schulz H, Engert A. Prophylactic antibiotics or G-CSF for the prevention of infections and improvement of survival in cancer patients undergoing chemotherapy. Cochrane Database Syst Rev. 2009 Jan 21;(1):CD007107. [PubMed Citation] Kaushansky KN. Lineage-specific hematopoietic growth factors. N Engl J Med. 2006 May 11;354(19):2034-45. [PubMed Citation] Waselenko JK, MacVittie TJ, Blakely WF, Pesik N, Wiley AL, Dickerson WE, Tsu H, Confer DL, Coleman CN, Seed T, Lowry P, Armitage JO, Dainiak N; Strategic National Stockpile Radiation Working Group. Medical management of the acute radiation syndrome: recommendations of the Strategic National Stockpile Radiation Working Group. Annals of Internal Medicine 2004; Vol. 140:1037-51. [PubMed Citation] Smith TJ, Khatcheressian J, Lyman GH, Ozer H, Armitage JO, Balducci L, Bennett CL, Cantor SB, Crawford J, Cross SJ, Demetri G, Desch CE, Pizzo PA, Schiffer CA, Schwartzberg L, Somerfield MR, Somlo G, Wade JC, Wade JL, Winn RJ, Wozniak AJ, Wolff AC. 2006 update of recommendations for the use of white blood cell growth factors: an evidence-based clinical practice guideline. J Clin Oncol. 2006 Jul 1;24(19):3187-205. Epub 2006 May 8. [PubMed Citation] Kuderer NM, Dale DC, Crawford J, Lyman GH. Impact of primary prophylaxis with granulocyte colony-stimulating factor on febrile neutropenia and mortality in adult cancer patients receiving chemotherapy: a systematic review. J Clin Oncol. 2007 Jul 20;25(21):3158-67. [PubMed Citation] Sung L, Nathan PC, Alibhai SM, Tomlinson GA, Beyene J. Meta-analysis: effect of prophylactic hematopoietic colony-stimulating factors on mortality and outcomes of infection. Ann Intern Med. 2007 Sep 18;147(6):400-11. [PubMed Citation] Management of febrile neutropenia Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA, Raad II, Rolston KV, Young JA, Wingard JR, Infectious Diseases Society of America. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2011 Feb 15;52(4):427-31. [PubMed Citation] Gafter-Gvili A, Fraser A, Paul M, van de Wetering M, Kremer L, Leibovici L. Antibiotic prophylaxis for bacterial infections in afebrile neutropenic patients following chemotherapy. Cochrane Database Syst Rev. 2005 Oct 19;(4):CD004386. [PubMed Citation] Gafter-Givili A, Fraser A, Leibovici L; Meta-analysis: antibiotic prophylaxis reduces mortality in neutropenic patients. Ann Int Med 2005; 142(12);975-995 [PubMed Citation] Paul M, Leibovici L; Systematic reviews and meta-analysis of febrile neutropenia. Mayo Clin Proc 2005;80(9):1122-1125. [PubMed Citation] Brook I, Elliott TB, Shoemaker MO, Ledney GD, Antimicrobials in the mangement of post-irradiation infection (PDF - 61 KB) (NATO RTG-099, 2005) top of page

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