Akut Radyasyon Sendromunda Destekleyici Bakım, TBI Ölümcüllüğü, Kök Hücre Kurtarma Tedavisi
Özet
Akut Radyasyon Sendromu (ARS), yüksek dozda iyonlaştırıcı radyasyona maruz kalınmasıyla ortaya çıkan; hematopoetik, gastrointestinal ve nörovasküler sistemleri etkileyen ciddi bir klinik tablodur. Total Vücut Işınlaması (TBI) sonrasında hasarın şiddeti; doza, doku tipine ve maruziyet süresine göre değişmekte olup, 2 Gy altındaki dozlarda kemik iliği kendini onarabilirken, yüksek dozlar ölümcül sendromlara yol açar. Doz tahmini; personel dozimetreleri, lenfosit sayımı, kusma zamanı ve kromozom aberasyon testleriyle yapılır. Tedavide METREPOL skorlama sistemiyle hastalar sınıflandırılarak sıvı dengesi, enfeksiyon profilaksisi ve G-CSF gibi sitokin destekleri uygulanır. Hematopoetik kök hücre nakli (HKHT) ise geri dönüşümsüz organ hasarı olmayan ve 7-10 Gy doz alan ağır vakalarda 14-21 günlük izlemden sonra düşünülür. Ancak, donör bulma zorlukları, engraftment sendromu ve immünosupresyon riskleri nedeniyle HKHT'nin ARS vakalarındaki başarı oranı klinik olarak halen tartışmalıdır.
Acute Radiation Syndrome (ARS) is a severe clinical condition resulting from high-dose ionizing radiation exposure within a short period, characterized by hematopoietic, gastrointestinal, and neurovascular symptoms. Following Total Body Irradiation (TBI), injury severity depends on the dose, tissue type, and exposure rate; while bone marrow damage can recover below 2 Gy, higher doses lead to fatal syndromes. Dose estimation relies on personnel dosimeters, absolute lymphocyte counts, time to emesis, and chromosome aberration assays. Based on the METREPOL scoring system, management includes fluid regulation, infection prophylaxis, and cytokine supports like G-CSF. Hematopoietic stem cell transplantation (HSCT) is considered for severe cases exposed to 7-10 Gy without irreversible organ damage, following a 14-21 day observation period. However, due to challenges in donor matching, engraftment syndrome, and immunosuppression risks, the success rate of HSCT in ARS remains clinically controversial.
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