elevated alkaline phosphatase.
A flexible
sigmoidoscopy and mammography were negative,
blood count was normal, and Papanicolaou smear
was class I.
She had carcinoma of the
endometrium in 1979 which was effectively treated
by total abdominal hysterectomy. Septicemia and
nonketotic hyperosmolar diabetic coma werelisted
on her death certificate as the causes of death.
Subject No. 14. This 54-year-old woman died
on Ebeye in 1990. When last seen by the
Brookhaven team in October 1989 she was taking
glyburide for diabetes mellitus and had a fasting
glucose of 208 mg/dl and a HbAIclevel of 7.4%
(mildly elevated). A blood count was normal.
Other problems considered earlier were bilateral
cataracts, fibrocystic disease of breasts with
negative mammogram in May 1989, negative
Papanicolaou smear in 1988, and normalflexible
sigmoidoscopy in 1987. The cause of death is
unknown.
Laboratory Findings:
Hematology
A teview of “blood counts" (average
concentrations of formed blood elements) of the
different exposure groups during the four-year
reporting period does not reveal any systematic
differences among groups. In 1989 and 1990 there
was a significant increase in mean platelet count
in Utirik exposed women as compared to the
unexposed population (Table 1). Figure 2 is a
continuation graph in which hematologic data of
the two exposed groupscollected since 1956 are
portrayedin relation to the expanded Comparison
group. Table I gives the mean values (+ /- SD)
from which Fig. 2 is derived. The individual
counts are given in Appendix B.
It is apparent from scanning the four graphs in
Fig. 2 that there ism mild butrelatively consistent
depression, genedéilly ‘aot statistically significant
different, over moat‘efthe 37 post-exposure years,
of neutrophil, lymphocyte, and platelet
concentrations (the latter in males only) in the
Rongelap/Ailingnae group.
This depression
appears to be of no clinical significance. These
consistently slightly lower values for all three
formed blood elements over such a long period in
the Rongelap group suggests the possibility of
radiation related mild impairment of
hematopoiesis. However, there is no evidence of
impaired leukocytosis in response to infection.
Therefore, these differences may reflect a shift in
cell compartmentalization (e.g. margination).
Hematologic changes in Japanese atomic bomb
survivors have been recently reviewed (Finch and
Finch, 1988). An early decline in leukocyte counts
was detected from 1947 through 1956, but this
occurred in both exposed and unexposed groups,
and therefore was not an effect of radiation.
Indeed, “no clearly established exposure differences
have been uncovered except in the case of the
leukemias” (Blaisdell and Amamoto, 1966).
Therefore, a sustained depression in leukocyte
counts, such as seen in the Rongelap group, was not
detected among the exposed Japanese. With regard
to leukocyte margination, no evidence of a radiation
dose-effect in the exposed Japanese was apparent
when exercise-induced leukocytosis was quantified
(Belsky et al., 1972).
In general, radiation has been found to alter
leukocyte function in humans only minimally, if at
all, and, when dysfunction has been detected, it has
been of no clinical importance. The most recent
clinical study to confirm this was carried out on
Japanese atomic bomb survivors and included
phagocytic and bactericidal activities of neutrophils
(Sasagawaet al., 1990).
It was noted that for ten years after the atomic
bombings in Japan the leukocyte counts of persons
followed by the Atomic Bomb Casualty Commission
gradually decreased by about 35% in both the
exposed and unexposed populations (Blaisdell and
Amamoto, 1966). This trend was never completely
explained, but the decline was chiefly attributable to
a decrease in neutrophils. A slight trend in this
direction can be detected in total leukocyte counts
obtained on the Marshallese over a similar time
span. Using data from the unexposed Comparison
group, the mean total leukocyte concentration for
1954-1958 was 8,500/ul and for 1969-1974 it was
7,300/ul, a 14% decline. For 1985-1990 it has been
A decrease in absolute lymphocyte
7,500/ul.
concentration, approximately 1,000/ul, occurred
simultaneously. This finding differs from that of the
Japanese, in whom it was the neutrophils that were
For the Marshallese,
predominantly lowered.
minimal fluctuation was seen in neutrophil count for
the three periods. The reason for the apparent
decrease in lymphocyte concentration in both
exposed and unexposed Marshallese is unknown.