Effects of the Low Dose Ionizing Radiation (X-ray) on Human Blood Components during Catheterization Process

Introduction

Ionizing radiation (IR) such as gamma and X-ray has an external effect on human body. The energy of IR is high enough to ionize atoms of the medium. As a result of interactions production of free radicals, breaking Effects of the Low Dose Ionizing Radiation (X-ray) on Human Blood Components during Catheterization Process chemical bonds, cross-linkages between macromolecules, and destructing of molecules in human cells that regulate vital cell operations; in turn it may cause cancer. Fortunately, cells are built to rebuild and repair themselves to certain levels of damage at most clinical radiation exposures involve low doses of <1 Gy, while higher doses can give rise to cell death [1].

Many studies have been done to find and analyze the evaluation of high and low dose ionizing radiation on hematological parameters. For instance, [2] analyze the blood variations resulting from both irradiation and time Med & Analy Chem Int J

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for animal rats. They found a significant reduction in WBC, platelet and RBC counts one day after irradiation increases with increasing the dose started from 0.3 to 1Gy [3] found the low dose rate on rat and dog effect the hemopoietic failure according to both total absorbed dose and on the dose-rate of multi exposures.

Fluoroscopy is an ideal continuous X-ray devise used in Cardiac catheterization laboratory for medical imaging. It is used often in a lot of different exploring and the operation in steps of diagnoses or treatments of heart diseases patients. It leads the operator by a continuous images (as movie) a beam that passed through the body on a monitor. From monitor the operator follow and direct the movement of a catheter through blood vessels, also place stents or other devices to open the blocked blood vessels [4].

In front of the above advantages of Fluoroscopy, it involves some risks and may cause potential hazardous situations for patient and the worker, as do other X-ray operations. The radiation dose and the time of operation are of the most important controlled parameters that the patient is subjected to, which vary from one patient to another depending on the individual procedure. The equivalency of X-ray irradiation to gamma irradiation is reported in several publications [5, 6]. Specifically, their ability to deactivate T lymphocytes and all blood components such as red cells, white cells, platelets and granulocytes at a same absorbed dose [7, 8].

The aim of the present work is to evaluate and analyze the effect of low dose X-ray radiation during the CT operation on some blood components of 33 patients. The considered parameters are Red Blood Cell count (RBC), the amount of hemoglobin (Hb), Red cell Distribution Width (RDW), Mean Corpuscular Volume (MCV) and White Blood cell Count (WBC).

Material and Methods

The CT operations have been carried out according the UNSCEAR judgments and regulations at low dose radiation health effect on non-targeted effects. Based on one Cather device (Cardiac catheterization, SN: 1Q1168VR02 (one face) For GE medical system) available in the Azadi general Duhok hospital, data have been collected for 33 heart diseases patients (11 male and 22 female) during a period of about 6-month in 2018. The dose rates of X-ray source recorded by Fluoroscopy have been varied from minimum of (0.78 mGy/h) to maximum of (6.53 mGy/h) with an average of (2.08 mGy/h). While the duration time of CT operations are varied from 0.6 m to 11.2 m, with an average of 2.91 m. Accordingly, the total dose recorded in the monitor are 89 mGy, 820 mGy and 287 mGy as minimum, maximum and average respectively. These low dose rates are in accordance with the dose rate recommended by the (UNSCEAR 1993).

The laboratory examinations covered a Complete Blood Picture (CBP) to account number of all components in the blood. Hematological parameters (HPs) or (CBC) for all patients are measured by an Automatic hematologic Swelab Alfa basic boule medical a.b analyzer (SN: 11018) at laboratory of Azadi Teaching Hospital. The blood analysis of each patient has been carried out twice by the same laboratory, to ensure the same standard protocol, the first wright before CT while the second in the early post-irradiation period, i.e. within one day of CT operation, for all patients.

Statistical Analysis

All data were statistically analyzed; the main two parameters used in measurement of area are the mean and standard deviation. The standard deviation is a theoretical expectation of 68.27% of the measurements of the sample’s data that lie within one standard deviation on both sides of the mean under normal distribution.

Statistical analysis was carried out by Social Science Statistics Package (SocSciStatis.com [9]) for P-value and t- test Calculation for two independent groups (pre, as control groups, and post radiation groups) with the aid of EXCEL software for calculations related to normal distribution of the difference between them (post – pre). This software were conducted to investigate the significant difference between the two groups for RBC count, the amount of hemoglobin Hb, RDW, MCV and WBC count. The statistical tests for comparison of numerical variables between groups have been carried out to evaluate the sample distribution normality. The condition of accepting the fitted normal distribution of the sample at a chosen at significance level (p-value = 0.05) is the critical value of P-value not to be greater than 0.409 [10].

Results and Discussion

Hematological parameters for 33 adult patients (of an average age of 57 years) groups were statistically analyzed and differences between the groups of samples irradiated with mean dose of 287 mGy and the pre- irradiation control groups of samples are examined statistically. All statistical results for post-irradiation group compared to the pre-irradiation control group of Medicinal & Analytical Chemistry International Journal

erythrocyte count or RBC, plasma hemoglobin Hb, RDW, MCV and WBC are given in Table 1.

Variables Mean SD Min. value Max. value t-value P Pre RBC x10¹²/L 4.84 0.59 3.5 5.8 2.65 0.0051* Post RBC x10¹²/L 4.47 0.55 3.43 5.6 Pre Hb (g/dl) 12.71 1.62 9.7 15.2 1.95 0.0279* Post Hb (g/dl) 11.95 1.55 9 15.2 Pre RDW 11.9 1.32 10.6 17.9 1.42 0.081 Post RDW 12.38 1.41 11 18.9 Pre MCV ( fL ) 81.98 6.05 61.5 93.7 0.25 0.401 Post MCV ( fL ) 82.37 6.24 62.2 94.5 Pre WBC x109/L 7.58 1.577 4.6 11.3 1.79 0.039* Post WBC x109/L 6.87 1.581 4 10.3

Our result of Hb is in contrast to results obtained in the case of gamma irradiation of blood transfusion from blood bank unit by Yousuf, et al. [13] where plasma Hb increases very little in post-irradiation that was mainly because of the complications accompanied by transfusion not by ionizing radiation. Table 1 shows also the RDW and MCV values pre and post-irradiated samples. The levels of RDW (row 5 and 6) in post and pre-irradiated samples are 12.38 ±1.41 and 11.9±1.32 mmol/L respectively, with P-value =0.081. Similarly the MCV values, which show negligible increase (row7 and 8) are 82.37±6.24 fL and 81.98 ±6.05 fL in post and pre-irradiated samples respectively, with P=0.401. It is very clear there are no significant changes observed between pre and post- irradiated levels, specifically in MCV level since p-value is To highlight the effect of X-ray at the day of irradiation on the parameters undergo a statistically significant decreases between groups regarding the mean, a theoretical expectation of 68.27% of the measurements of the sample’s data that lie within one standard deviation on both sides of the mean under normal distribution are carried out. Figure 1 shows a normal distribution of highly statistically significantly decreases in RBC counts for 68% Z-value. For this Z-value the decreases for 1σ range is shown in Figure 1 and the mean values of the difference (post – pre) sample is -0.376 ± 0.340 x1012/L.

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Similarly, Figure 2 and 3 show the normal distribution of highly statistically significantly decreases in plasma hemoglobin Hb with the mean of difference -0.757 ± 0.843 g/dL and WBC counts with the mean of difference - 0.706 ± 1.043x109/L.

Click to enlarge

Click to enlarge

Conclusion

The present study showed that the low level X-ray irradiation, during CT, significantly decreases the erythrocyte (RBC) counts, plasma Hb and WBC counts in blood post-irradiated. The dehydration through the membrane of erythrocytes might be the cause of decreasing RBCs parameters. Even though the quantitative results of the mean percent-hemolysis level is still within the recommended acceptable levels for clinical significance use. Concerning parameters measure the shape, size or volume of red blood cell; there are no noticeable or significant changes in both RDW and MCV shape in pre and post-irradiated samples.

According to these results, it is obvious to assume that irradiated RBC units are clinically safe and of acceptable in CT operation, specifically knowing the capability of blood cell’s units to rebuild and repair themselves to certain levels of damage at low dose exposure. This study is not able to conclude that X-ray irradiation was the only cause of such change in blood parameters. Further works are required to search the other possible effects.