Figure A

Figure A Changes of granulocyte counts following different doses of whole body exposure

Figure B Haematological chart from 8 January to 8 April 1999. Granulocyte colony stimulating factor given between given between 13 January and 22 January

Figure C International symbol for radiation danger

Table A Differential diagnosis of local radiation injury from thermal burns

Thermal burns	Local radiation injury
Prompt pain	Initially painless.
Patient knows the exact time of injury	Patient usually does not remember the time of exposure
Severe inflammatory response, cell death, and tissue destruction appear immediately in the affected region	Evidence of cell death is not apparent until epidermal surface layers are shed and local cell renewal systems have failed
All types of cells and tissue components are damaged	Damages to the cell components are not homogenous due to variability of sensitivity of different cell types to ionising radiation

Box A:
Blood counts presented on fig B were started four weeks after the accidental whole body exposure when the radiation sickness was recognised. A total of 10 scrap metal dealers were exposed to an abandoned radiotherapy source (cobalt-60, 3.3 TBq (91 Ci)) in Istanbul for about 7 hours on 13 December 1998. (Becquerels (Bq) and curies (Ci) are the units of radioactivity; 1 Bq is 1 decay per second; 1 Ciº 3.7´ 10¹⁰ Bq.)
At hospitalisation on 9 January 1999, due to unclear prolonged weakness and gingival bleeding, both granulocytes and platelets were fewer than 1000 mm^-3, lymphocytes were not counted. Cytokine treatment (granulocyte colony stimulating factor, neupogen, 8.0 m g/kg/day) effectively stimulated the granulopoesis after 5 days. Four days later it was stopped. The whole body dose was assessed in the range of half-lethal.²² Patient MI was treated with wide spectrum antibiotics and antiviral and antifungal drugs for one month. He was discharged from the haematological department on the 40th day. He has regularly been followed up and consulted by BG since then. Blood counts stabilised in the normal range slowly, only after six months.^w1
w1 Günalp B, Ergen K, Turai I. Follow-up of delayed health consequences of the Istanbul radiological accident and the lessons to be learned from its medical management. Vienna: IAEA, 2002:67-75. (IAEA TecDoc 1300.)