Start as an Emergency Physician

The oncology doctor was a little speechless.

The hematologist sighed and explained, "We chose peripheral blood stem cell transplantation because it would reduce the incidence and severity of graft-versus-host reactions after surgery... However, your daughter has chronic myeloid leukemia..."

Zhou Yuan frowned.

Chronic myeloid leukemia is a type of leukemia that has three stages of development, onset, accelerated and blast crisis.

The disease is stable at the onset and can last for one to four years, except for fatigue, low-grade fever and other manifestations of hypermetabolism, there is only one clinical manifestation of splenomegaly.

The accelerator will quickly develop more symptoms such as anemia, and then soon reach the blast crisis, at this time, if the treatment is carried out, the treatment effect and prognosis will be much worse than that of the primary acute leukemia, which usually leads to death...

In other words, if a bone marrow transplant is performed, there will be a more pronounced rejection reaction between the immunocompetent cells in the graft tissue and the tissue of the immunosuppressed, tissue-incompatible antigen recipient, i.e., the graft-versus-host response.

"There is a high chance that GVHD (graft-versus-host reaction) will occur, which is a major obstacle to bone marrow transplantation, and even if successful, there are a number of complications that can occur... Without peripheral blood stem cell transplantation, we are not sure to prevent graft-versus-host reactions!" says the oncologist.

Liu Huimin and He Jianyi were also stunned at the same time.

Haoyue's physical condition is very poor now, and her immune system has basically been destroyed, and she can't survive the complications of necrosis of cells in the skin, liver, or digestive tract.

The atmosphere in the operating room became heavy.

Zhou Yuan also pondered.

The graft-versus-host response is due to the rejection of the transplanted bone marrow from the patient, which is unavoidable, but... A series of postoperative complications can be minimized by intraoperative management.

With a masterful bone marrow transplant, you might be able to take the plunge and give it a try.

No matter what, it's better than letting Haoyue wait to die.

After a moment of silence, Zhou Yuan walked up to Liu Huimin and said, "I have a certain degree of certainty that I can complete the bone marrow transplant, but you have already undergone mobilizer injections before, and all the states of your body are preparing for peripheral blood stem cell transplantation." "

"As a result, you may be in pain, and since the peripheral blood stem cell transplant has not been able to extract hematopoietic stem cells from your peripheral blood, a large amount of bone marrow may need to be drawn to collect hematopoietic stem cells..."

Zhou Yuan's words are here, and the rest can only be left to Liu Huimin to choose.

Oncology and hematology doctors are afraid to do it precisely because it is too difficult and may cause too many postoperative complications, such as infection, which is the main cause of chronic graft-versus-host reactions.

Zhou Yuan can try his best to make up for these problems through technology, and as for various immunodeficiency diseases in the future, they will inevitably occur, and they can only rely on the patients themselves.

Liu Huimin was stunned for a moment, and immediately said: "Do a bone marrow transplant!"

She didn't hesitate, but was stunned by Zhou Yuan's words.

Will he still have a bone marrow transplant...

If it was before, Liu Huimin maybe, but when the delicate and difficult operations were completed perfectly in his hands, Liu Huimin subconsciously believed that Zhou Yuan could also successfully perform this operation.

"Dr. Zhou, my daughter's life... No, my daughter and I have to pay for it! You can take as much bone marrow as you want, you can give her mine, you must save her!"

Liu Huimin's voice was a little choked.

At this time, she no longer cared about the image of the deputy director, lying on the operating bed, she was just a patient and a mother.

Zhou Yuan nodded and looked at He Jianyi.

He Jianyi gave a trusting look: "Let it go!"

"Director..." The doctors in the hematology and oncology departments were stunned.

"This operation is too dangerous, and there is no way to guarantee that the transplant will be completed on the patient's side for a bone marrow transplant..."

Zhou Yuan said lightly: "I will also do the surgery on the patient's side." "

In his head, information about hematopoietic stem cell transplantation flooded out.

"Prepare 2.5 vials of NS-500 ml mixed heparin 37250. "

He Jian nodded and stood next to Zhou Yuan.

This action says it all.

The two doctors from the Department of Hematology and the Department of Oncology looked at each other, no longer hesitated, and immediately began to prepare.

"Donor, patient medical records. Zhou Yuan said when he looked at the equipment.

He didn't know about Liu Huimin and his daughter Haoyue.

"The HLA type is the same, the donor's blood type is A, the patient's blood type is AB, the patient's weight is 47kg, and other indicators meet the surgical requirements. "The hematologist picked out a few important ones.

Zhou Yuan nodded, and then ordered: "Prepare two hundred 20m1 disposable syringes, five No. 16 and No. 9 needles, and five bone punctures." "

The operation was performed on an ad hoc basis, and as a result, many surgical instruments were not prepared.

"The anesthesiologist, preparing for epidural anesthesia, closely monitors blood pressure, heart rate, breathing and electrocardiogram (ECG). "

Soon, everything was ready.

Under the shadowless lamp, Liu Huimin's face was a little old, looked at the familiar colleagues around her, sighed, and said: "I have performed so many surgeries on people, I have never been afraid, I didn't expect to come up and lie down like this, and my whole body is chilling..."

Zhou Yuan comforted: "Director Liu, don't worry, your daughter will be fine." "

"Zhou Yuan, I believe in you. "

Zhou Yuan nodded and looked at He Jianyi, "Teacher, you come to extract NS+ hormone, hematologists and oncologists, please assist in bone marrow filtration and cell counting, and I will take bone marrow." "

After speaking, Zhou Yuan took a deep breath: "Anesthesiologist, start anesthesia." "

The anesthesiologist was already ready, heard the instructions, and quickly completed the epidural.

The anesthetic took effect, and Zhou Yuan said, "The operation begins." “

"Disposable syringes. Heparin NS was extracted. Volume 2.5ml. "

He Jian nodded, took a 20ml disposable syringe, took out 2.5m1 of heparin NS, and handed it to Zhou Yuan.

Zhou Yuan carefully threaded the needle bone in the iliac front and sucked the bone marrow into the needle.

The 20 ml needle tube finally stopped after aspirating 7.5 ml of bone marrow.

This is the cumbersomeness of bone marrow transplantation, each time the needle is inserted into the bone and the marrow is extracted, the amount of marrow can not exceed 10ml, and the ratio of bone marrow blood to NS fluid should be controlled at 3:1, that is, 2.5m1 heparin NS per tube, only 7.5m1 of bone marrow fluid can be added.

After the bone marrow was extracted, Zhou Yuan did not directly take the doctors of hematology and oncology.

"16 gauge needle. "

Next, Zhou Yuan used a 16-gauge needle and a No. 9 needle to filter the extracted bone marrow.

The hematology doctor handed over the sterilized plastic bag, and the filtered bone marrow needed to be stored inside.

But Zhou Yuan shook his head: "No, additional treatment of the bone marrow is still needed..."

"Additional treatment?" the two doctors in the hematology and oncology departments were stunned.

Are there any additional treatments for this step of the bone marrow transplant procedure?_

Feilu reminds you: there are three things to read - collection, recommendation, and points