Abstract
This review explores the effects of ionizing radiation on blood and its components, focusing on its applications, biological impacts, and implications for medical and occupational settings. Ionizing radiation is a cornerstone of modern medicine, playing a critical role in diagnostic imaging, cancer treatment, and preventive measures, such as the irradiation of blood units to prevent transfusion-associated graft-versus-host disease. However, it also induces significant alterations in blood cells, including genetic damage, immune suppression, and changes in hematological, biochemical, and hemorheological parameters, depending on the dose, dose rate, and type of radiation. Conventional radiotherapy, hadron therapy, and the emerging FLASH modality exhibit distinct effects on blood. Hadron therapy and FLASH radiotherapy could reduce oxidative stress preserving red blood cell deformability more effectively than conventional methods, thereby minimizing systemic toxicity. However, the underlying mechanisms remain a topic of ongoing investigation. Additionally, studies reveal how different types of radiation, including gamma rays, X-rays, electron beams, and hadrons, uniquely influence blood cells, underscoring the complexity of radiobiological interactions. Challenges and controversies, such as the long-term hematological impact of radiation exposure, individual variability in response, and the potential of radioprotective strategies and immune system stimulation are also addressed. Insights into hemorheological changes and the development of personalized approaches are critical for optimizing therapeutic outcomes and safety protocols. By synthesizing current knowledge, this review emphasizes the need for further research on the effects of ionizing radiation on blood to bridge gaps in understanding and enhance clinical and practical applications.