Overview
Radiation agranulocytosis is a potential complication of radiation therapy, particularly when large volumes of bone marrow are irradiated. It is characterized by a severe reduction in neutrophils, increasing the risk of infection.Diagnosis
Diagnosis is based on a peripheral blood count demonstrating severe neutropenia (absolute neutrophil count <500/µL) in a patient who has received radiation therapy.
The nadir (lowest point) of the neutrophil count typically occurs 7 to 14 days after radiation exposure.Management
Management is primarily supportive, focusing on preventing and treating infections.
Granulocyte colony-stimulating factors (G-CSFs) may be used to accelerate neutrophil recovery.
Prophylactic antibiotics may be considered in high-risk patients.
Radiation therapy planning should aim to minimize the dose to large volumes of active bone marrow.Key Recommendations
Radiation oncologists should use their judgment to apply practice parameters to individual patient practices 1.
Radiation therapy requires detailed attention to equipment, patient and personnel safety, equipment maintenance, and quality assurance 1.
The guiding principle of radiation oncology is to limit radiation exposure 1.References
1 Lo S, Chao S, Harris E, Knisely J, Luh JY, Mohindra P et al.. ACR-ARS Practice Parameter for Radiation Oncology. American journal of clinical oncology 2024. link