PATHOPHYSIOLOGY

MANIFESTATIONS:

• Reduced numbers of leukocytes, erythrocytes, and platelets

• Pain from an enlarged liver andspleen

• Bone pain from expansion of marrow

• Headache

• Vomiting

• Anemia

• Bleeding tendaencies

• Fever

• Weakness

• Hyperplasia of gums

DIAGNOSTIC EXAMINATION

• Bone marrow analysis

 • Complete blood count

MANAGEMENT:

• EAS PAIN AND PROVIDE COMFORT

 Position the client, prevent undue pain in abdomen, lymphnodes, joints and bone

 Administer acetaminophen

 Listen actively in patients enduring pain

• Maintaining adequate nutrition

 Encourage adequate nutrition by carefully timing of chemotherapeutic drug

administration ang prophylactic use of antiemetics

 Give oral hygiene to prevent oral lesions and promote appetite

 Maintain calorie counts and formal nutritional assessment

• Maintain fluid and electrolyte balance

 Measure inatake and output

 Assess for fluid overload and dehydration

• Decrease fatigue and deconditioning

• Improve self-care

• Manage anxiety and grief

• Promote positive body image

• Encourage spiritual well being

• Promote home and community-based care

Health Education (DOH)

Environmental Health
Environmental Health is concerned with preventing illness through managing the environment and by
changing people's behavior to reduce exposure to biological and non-biological agents of disease and
injury. It is concerned primarily with effects of the environment to the health of the people.

Program strategies and activities are focused on environmental sanitation, environmental health impact
assessment and occupational health through inter-agency collaboration. An Inter-Agency COmmittee on
Environmental Health was created by virute of E.O. 489 to facilitate and improve coordination among
concerned agencies. It provides the venue for technical collaboration, effective monitoring and
communication, resource mobilization, policy review and development. The Committee has five sectoral
task forces on water, solid waste, air, toxic and chemical substances and occupational health.

Vision:

Health Settings for All Filipinos

Mission:

Provide leadership in ensuring health settings

Goals:

Reduction of environmental and occupational related diseases, disabilities and deaths through health
promotion and mitigation of hazards and risks in the environment and worksplaces.

Strategic Objectives:

1. Development of evidence-based policies, guidelines, standards, programs and parameters for specific
healthy settings.

2. Provision of technical assistance to implementers and other relevant partners

3. Strengthening inter-sectoral collaboration and broad based mass participation for the promotion and
attainment of healthy settings

Key Result Areas:

• Appropriate development and regular evaluation of relevant programs, projects, policies and
plans on environmental and occupational health
• Timely provision of technical assistance to Centers for Health Development (CHDs) and other
partners
• Development of responsive/relevant legislative and research agenda on DPC
• Timely provision of technical inputs to curriculum development and conduct of human resource
development
• Timely provision of technically sound advice to the Secretary and other stakeholders
• Timely and adequate provision of strategic logistics

Components:

• Inter- agency Committee on Environmental Health

• IACEH Task Force on Water
• IACEH Task Force on Radiation
• IACEH Task Force on Solid Waste
 • IACEH Task Force on Toxic Chemicals
• IACEH Task Force on Occupational Health
• Environmental Sanitation
• Environmental Health Impact Assessment
• Occupational Health

http://www.doh.gov.ph/programs/environmental_health.html

RECORDING AND REPORTING

Radiation-induced leukemia
Hromas et al described AML1 gene translocations in persons who previously had experienced "high-level
radiation exposure from nuclear explosions. The authors indicated that they were describing a novel
syndrome of radiation-associated acute myeloid leukemia involving AML1 gene translocations. There is
no evidence, however, that any of the 3 persons in this study received "high-level radiation exposure" or,
in fact, received any significant amounts of radiation exposure to the bone marrow, as judged from the
brief descriptions of their exposures. The science of assigning a bone marrow radiation dose is precise,
and without accurate and detailed radiation exposure information, it is virtually impossible to tell whether
an individual was excessively exposed or possibly had received a bone marrow radiation dose in the
leukemogenic range. For example, case 1 may have received trace amounts of downwind exposure and
probably would not have been allowed close enough to an atomic bomb detonation to have received any
appreciable radiation dose. The amount of radiation received by the second person, who allegedly took a
picture of ground zero in Hiroshima 2 weeks after the nuclear explosion, would have been negligible,
even if he had been standing at ground zero. Hypocenter radiation decayed rapidly during the first few
hours after detonation. It has been reported that anyone working 10-20 hours a day at the Hiroshima
hypocenter beginning at day 1 for the week following the bomb would have received a radiation dose of
about 0.1 Gy, an amount of radiation well below the lowest significant dose shown to be leukemogenic
for humans from the Hiroshima and Nagasaki atomic bomb exposures. Case 3 is said to have worked for a
company that removed debris from ground zero. The nature and duration of his work with the company
was not described, so that no meaningful radiation dose can be assigned. He most likely would have
carried some type of radiation dosimeter if he had been at risk of excessive exposure.

The fact that all 3 cases of leukemia were preceded by a significant pancytopenic phase is much more
consistent with the type of secondary leukemia induced by chemical or chemotherapeutic agents than
those reported due to sublethal amounts of total body radiation exposure. The cases of acute leukemia in
the atomic bomb survivors of Hiroshima and Nagasaki clinically resembled the primary types of acute
leukemia that occur in nonexposed persons, and rarely did they experience a preleukemic pancytopenic
phase.

Finally it is important to emphasize that it is not possible to identify any individual case of leukemia as
radiation induced. To date no specific markers of radiation exposure have been described, and, even
though some chromosomal and genetic abnormalities may be more prevalent in persons with leukemia
and a history of exposure to excessive amounts of radiation than nonexposed persons with leukemia, none
of the changes have been shown to be specific for radiation induction of the leukemia.

Stuart C. Finch
The Cooper Health System Camden, New Jersey

EVALUATION:

RADIATION. In physics, radiation describes any process in which energy travels through a
medium or through space, ultimately to be absorbed by another body. Radiation can simply be found
around us.

Radiation, a form of energy abundant in nature, has been harnessed by man to provide hundreds
of beneficial uses. Controlled use of radioisotopes, which are found in nature as well as made by man, are
used in X-rays, medical diagnosis and treatment, common house-hold products such as television sets and
smoke alarms, and electricity from nuclear power plants, basic scientific research, manufacturing,
minerals explo-ration and agriculture.

A very small amount of ionizing radiation could trigger cancer in the long term even though it
may take decades for the cancer to appear. Ionizing radiation (x-rays, radon gas, radioactive material) can
cause leukemia and thyroid cancer. There is no doubt that radiation can cause cancer, but there still is a
question of what level of radiation it takes to cause cancer. Rapidly dividing cells are more susceptible to
radiation damage. Examples of radiosensitive cells are blood forming cells (bone marrow), intestinal
lining, hair follicles and fetuses. Hence, these develop cancer first.

If a person is exposed to radiation, especially high dose, there are predictable changes in our body that
can be measured. The number of blood cells, the frequency of chromosome aberrations in the blood cells
and the amount of radioactive material in urine, are examples of biomarkers that can indicate if one is
exposured high dose. If you do not have early biological changes indicated by these measurements the
radiation exposure will not pose an immediate threat to you.

The risk for radiation exposure has been very widely studied. The general consensus of opinion for the
induction of cancer by ionizing radiation is 10% increase in cancer rate/Sv when the dose is given over a
short time with a decrease to 5% when the dose is protracted over an extended time period. (one Sv is
equal to 1000 mSv and one mSv is equal to 100 mRem.). Therefore a 10% increase in cancer is related to
a dose of 100,000 mrem with 5% if the dose is protracted over a longer period of time.