At 1pm, four workers in a Chinese herbal medicine plant were working with a high-intensity cobalt-60 irradiation device when one of them noticed it had not been retracted properly after its last use. This resulted in one worker spending about 16 minutes in front of an 18,000 Curie source.  The man was brought in for care and exhibited vomiting, a fever (38.9 C), and facial flushing within 30 minutes after exposure. By 3am, the 32-year old man was transferred to the Affiliated Hospital of the Academy of Military Medical Sciences, in Beijing, China.

You are a physician working at the hospital. Upon his arrival, you review the radiation assessment and an inspection of his skin reveals diffuse erythema on the hands, face and trunk. In addition to ordering blood work to monitor his lymphocyte counts, you are considering treatment options including colony stimulating factors (CSF).

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The man's lymphocyte count continues to decline, and you decide that this patient would benefit from the colony stimulating factor filgrastim.

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Even with the initiation of CSF therapy, by 45 hours post exposure the man's lymphocyte count had decreased to zero cells per milliliter of blood, and the need for additional treatment was evident. By day 4, he had started exhibiting signs of clinical decline - including difficulty breathing, hypotension (blood pressure 84/56 mmHg), and hypoxemia (88% oxygen saturation). By day 7, his white blood cell count decreased to 100 cells per microliter.

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Once marrow tests revealed that there was too much damage to rely on autologous hematopoietic reconstitution, blood stem cell transplantation was pursued. Treatments were injected periodically throughout the 40 days post exposure. While improvement of WBC counts was documented, other complications led to the development of intestinal paralysis, obstruction, and shock. Emergency surgery was provided and removed 80% of the small intestine and colon, and despite best efforts and slow recovery of intestinal functions, the patient developed a pneumonia and sepsis, and died 14 days after surgery, a total of 62 days after exposure.