Polonium-210 poisoning: a first-hand account

BACKGROUND

Polonium-210 ((210)Po) gained widespread notoriety after the poisoning and subsequent death of Mr Alexander Litvinenko in London, UK, in 2006. Exposure to (210)Po resulted initially in a clinical course that was indistinguishable from infection or exposure to chemical toxins, such as thallium.

METHODS

A 43-year-old man presented to his local hospital with acute abdominal pain, diarrhoea, and vomiting, and was admitted to the hospital because of dehydration and persistent gastrointestinal symptoms. He was initially diagnosed with gastroenteritis and treated with antibiotics. Clostridium difficile toxin was subsequently detected in his stools, which is when he first raised the possibility of being poisoned and revealed his background and former identity, having been admitted under a new identity with which he had been provided on being granted asylum in the UK. Within 6 days, the patient had developed thrombocytopenia and neutropenia, which was initially thought to be drug induced. By 2 weeks, in addition to bone marrow failure, he had evidence of alopecia and mucositis. Thallium poisoning was suspected and investigated but ultimately dismissed because blood levels of thallium, although raised, were lower than toxic concentrations. The patient continued to deteriorate and within 3 weeks had developed multiple organ failure requiring ventilation, haemofiltration, and cardiac support, associated with a drop in consciousness. On the 23rd day after he first became ill, he suffered a pulseless electrical activity cardiorespiratory arrest from which he could not be resuscitated and was pronounced dead.

FINDINGS

Urine analysis using gamma-ray spectroscopy on day 22 showed a characteristic 803 keV photon emission, raising the possibility of (210)Po poisoning. Results of confirmatory analysis that became available after the patient's death established the presence of (210)Po at concentrations about 10(9)-times higher than normal background levels. Post-mortem tissue analyses showed autolysis and retention of (210)Po at lethal doses in several organs. On the basis of the measured amounts and tissue distribution of (210)Po, it was estimated that the patient had ingested several 1000 million becquerels (a few GBq), probably as a soluble salt (eg, chloride), which delivered very high and fatal radiation doses over a period of a few days.

INTERPRETATION

Early symptoms of (210)Po poisoning are indistinguishable from those of a wide range of chemical toxins. Hence, the diagnosis can be delayed and even missed without a high degree of suspicion. Although body surface scanning with a standard Geiger counter was unable to detect the radiation emitted by (210)Po, an atypical clinical course prompted active consideration of poisoning with radioactive material, with the diagnosis ultimately being made with gamma-ray spectroscopy of a urine sample.

FUNDING

UK NHS, Public Health England, and the UK Department of Health.

[Polonium-210 acute and chronic pathomorphology and pathogenesis]

In the present review, the data on the pathology of acute and chronic polonium injuries available from the an open-access domestic and foreign literature are primarily systemized and analyzed. The historical background of the research is presented in brief. On the basis of clinical and experimental generalizations, the current concept regarding the pathogenesis of polonium intoxication has been developed.

Variation of ²¹⁰Po daily urinary excretion for male subjects at environmental level

(210)Po was determined in 24-h urine of seven healthy males from Prague, Czech Republic, for ten consecutive days. The results show that for each volunteer, the urinary excretion of (210)Po changed only little from day to day in the studied time period. For two volunteers, the difference in the daily excreted (210)Po activity for two consecutive days was not significant, given the 95% confidence interval (two sigma) of the activity measurements. The same is valid for the excretion data of the other volunteers, except for some days where the differences were slightly higher. The range of daily urinary excretion of (210)Po of each volunteer in the studied time period was quite narrow. Among the volunteers, the maximum daily urinary excretion value of (210)Po was at most about a factor of 2.5 higher than the lowest excretion value. An attempt to explain the observed small inter-individual variability of (210)Po excretion in daily urine is made.

Relative biological effectiveness (RBE) of alpha radiation in cultured porcine aortic endothelial cells

PURPOSE

Northern peoples can receive elevated radiation doses (1- 10 mSv/y) from transfer of polonium-210 (210Po) through the lichen-caribou-human food chain. Ingested 210Po is primarily blood-borne and thus many of its short range alpha particles irradiate the endothelial cells lining the blood vessels. The relative biological effectiveness (RBE) of alpha particles vs. x-rays was examined in porcine aortic endothelial cells as a surrogate for understanding what might happen to human endothelial cells in northern populations consuming traditional foods.

MATERIALS AND METHODS

Cultured porcine aortic endothelial cells were exposed to x-ray and 210Po alpha particle radiation. Alpha irradiation was applied to the cell cultures internally via the culture medium and externally, using thin-bottomed culture dishes. The results given here are based on the external irradiation method, which was found to be more reliable. Dose-response curves were compared for four lethal endpoints (cell viability, live cell fraction, release of lactate dehydrogenase [LDH] and clonogenic survival) to determine the relative biological effectiveness (RBE) of alpha radiation.

RESULTS

The alpha RBE for porcine cells varied from 1.6-21, depending on the endpoint: 21.2+/-4.5 for cell viability, 12.9+/-2.7 for decrease in live cell number, 5.3+/-0.4 for LDH release to the medium but only 1.6 +/-0.1 for clonogenic survival. The low RBE of 1.6 was due to x-ray hypersensitivity of endothelial cells at low doses.

Polonium-210 as a poison

The death of Alexander Litvinenko on 23 November 2006 has brought into focus scientific judgements concerning the radiotoxicity of polonium-210 ((210)Po). This paper does not consider the specific radiological circumstances surrounding the tragic death of Mr Litvinenko; rather, it provides an evaluation of published human and animal data and models developed for the estimation of alpha radiation doses from (210)Po and the induction of potentially fatal damage to different organs and tissues. Although uncertainties have not been addressed comprehensively, the reliability of key assumptions is considered. Concentrating on the possibility of intake by ingestion, the use of biokinetic and dosimetric models to estimate organ and tissue doses from (210)Po is examined and model predictions of the time-course of dose delivery are illustrated. Estimates are made of doses required to cause fatal damage, taking account of the possible effects of dose protraction and the relative biological effectiveness (RBE) of alpha particles compared to gamma and x-rays. Comparison of LD(50) values (dose to cause death for 50% of people) for different tissues with the possible accumulation of dose to these tissues suggests that bone marrow failure is likely to be an important component of multiple contributory causes of death occurring within a few weeks of an intake by ingestion. Animal data on the effects of (210)Po provide good confirmatory evidence of intakes and doses required to cause death within about 3 weeks. The conclusion is reached that 0.1-0.3 GBq or more absorbed to blood of an adult male is likely to be fatal within 1 month. This corresponds to ingestion of 1-3 GBq or more, assuming 10% absorption to blood. Well-characterised reductions in white cell counts would be observed. Bone marrow failure is likely to be compounded by damage caused by higher doses to other organs, including kidneys and liver. Even if the bone marrow could be rescued, damage to other organs can be expected to prove fatal.

A systemic biokinetic model for polonium

Although the biokinetics of polonium has been studied extensively, interpretation of the data is complicated by potential differences with species and route of exposure and the questionable reliability of much of the reported excretion data for man. A study was undertaken to identify the data that are most likely to represent the typical behavior of polonium and apply those data to construct an improved, physiologically realistic systemic biokinetic model for polonium in man. Such a model is needed for interpretation of urinary excretion data for workers exposed to 210Po and reconstruction of the radiation doses received by those workers. This paper reviews the database on the biokinetics of polonium and describes a new systemic biokinetic model for polonium in man.

Regional variation in radionuclide concentrations and radiation dose in caribou (Rangifer tarandus) in the Canadian Arctic; 1992-94

Gamma-emitting radionuclides and 210Po, an alpha-emitting product of the 238U decay chain, were analysed in tissues from 16 caribou (Rangifer tarandus) collections in the Canadian North between 1992 and 1994. The study was conducted to determine the regional variability of anthropogenic and natural radionuclides in Canadian caribou, and to estimate the background radiation dose to caribou tissues. 137Cs, 40K, 210Pb and 210Po were consistently found in most herds. Mean muscle 137Cs varied from below detection limits on Banks Island to 231 Bq kg-1 wet weight (ww) in the Beverly herd in the central Arctic. Comparison of 1992-94 levels with published values from the 1960s and 1980s showed that 137Cs in caribou is declining with an effective half-life (Teff) of 9.9 years. The highest mean bone and liver 210Pb activities were observed on south Baffin Island, which included one bone sample with 3800 Bq kg-1 ww of 210Pb and 3070 Bq kg-1 ww of 210Po. The distribution of 137Cs and 210Pb between herds was attributed to higher atmospheric deposition rates between 60 and 65 degrees N, and changes in plant community structure and lichen species composition. The highest mean absorbed dose (30 mGy year-1) was observed in 1993 in the liver of caribou from Lake Harbour. This dose translated into a weighted absorbed dose of 300 mGy year-1, assuming a radiation weighting factor (wR) of 10 to account for the increased biological efficiency of alpha particles for deterministic effects. The Lake Harbour site also had the highest individual weighted absorbed dose in bone (810 mGy year-1) and liver (530 mGy year-1) in the study. There was no significant relationship between bone 210Pb activity and age for individual or pooled herds, indicating that the estimated doses are probably present throughout the lifetime of the caribou. Because some herds number several hundred thousand individuals, collective doses may also be very high. As yet, there have been no reports of observable effects due to these relatively high exposures and many of the herds continue to thrive and increase in size.