Treatment of Infectious Complications of the Hematopoietic Syndrome

Abstract

From a strictly therapeutic point of view, bone marrow failure resulting from irradiation presents three main challenges to the clinician: (1) to correct any metabolic disturbances, either of the hydroelectrolytic compartment or of a nutritional nature; (2) to compensate for cytopenias, particularly of granulocytes and platelets; and (3) to prevent or treat infections. These goals can be achieved only through supportive, substitutive, or compensative therapies. In this chapter, I summarize the principal therapies that have been adopted for preventing and treating the infectious complications of the hematopoietic syndrome—complications that derive basically from transient granulocytopenia, which usually lasts for about 2 weeks. Severe bone marrow failure appears when significant body volumes receive doses of about 4-6 Gy within a short period of time. The clinician must bear in mind that the hematopoietic syndrome can put the life of an irradiated person at risk. Patients with severe granulocytopenia (less than 100/pL) tend to develop early and possibly fatal infectious fevers. Despite the possibility that a concomitant hemorrhage might occur, which certainly would contribute to an increase in the mortality rate, it has seldom been observed in accidentally irradiated persons. Infectious complications are responsible for most fatalities. The basic rules adopted for preventing and treating infectious complications observed in accidentally irradiated persons do not differ substantially from those used for treating cancer patients who present granulocytopenia as a consequence of either the underlying disease or their chemotherapy or radiotherapy regimens.