Nuclear weapons and RDD detonations can result in radiation exposure, external and internal contamination, and concomitant trauma. Combined injuries have a synergistic effect leading to a poorer prognosis.24,25

Patients with hematopoietic subsyndrome of ARS will have an increased risk of infection and hemorrhage. Myeloid cytokine therapy and romiplostim should be initiated as soon as possible.24,26,27 Surgical procedures should be completed as soon as possible before lymphopenia and thrombocytopenia occurs. Use of cytokines may prolong the surgical window prior to cell line depletion. Transfusions should be accomplished with irradiated blood products, when possible.