Start as an Emergency Physician

Zhou Yuan nodded: "It can reduce the graft-versus-host reaction, and it can also reduce the probability of postoperative complications to a certain extent." "

Doctors in the departments of hematology and oncology looked at each other.

"Cell separator. Zhou Yuandao.

Zhou Yuan carefully moved the bone marrow to the blood cell separator and washed the bone marrow cells.

After a while, the bone marrow and blood cells were separated after centrifugation, and Zhou Yuan took out the bone marrow and transported the blood cells back to Liu Huimin's body.

"This is..."

Zhou Yuan took a new disposable needle, paused, and explained: "The donor's blood type is A, and the patient's blood type is AB, although it is said that A blood can be transported to AB blood, but now the bone marrow blood is added with heparin NS, and the donor's plasma has antibodies that agglutinate the patient's red blood cells..."

"Once the antibody titer is greater than 1/256, the patient's immune system is already compromised and there is no way to defend against the antibody, which will lead to the destruction of the patient's red blood cells, which will aggravate the graft-versus-host response. "

He Jianyi and the others were stunned.

Zhou Yuan didn't talk nonsense, and said, "Filter the bone marrow blood according to what I did just now." "

"Two intravenous lines were established, one for infusion, and the proportion of infusion was 2.5 to 3 times the amount of blood drawn from the bone marrow. The other delivers autologous blood to maintain the donor's blood volume and blood pressure. Both intravenous lines should have needles above 19 gauge. "

He Jianyi immediately opened the intravenous access.

Before the operation, the hematology doctors had already collected Liu Huimin's blood and blood components, and prepared to transplant it back into her body after peripheral blood stem cell transplantation to reduce the pain and sequelae after the operation.

At this time, it can be used for intraoperative blood pressure maintenance for bone marrow transplantation.

Seeing that the venous access was opened, Zhou Yuan picked up the needle that had already drawn heparin NS again, inserted the needle along the hole of the previous bone puncture, and extracted the bone marrow again.

Only 7.5 ml of bone marrow blood can be drawn each time, and the final amount is about 800 ml.

However, what patients actually need is hematopoietic stem cells in the bone marrow blood, so there are actually not many hematopoietic stem cells extracted from the 800 ml of bone marrow blood.

That's why 200 disposable syringes are prepared.

In addition to the tedious process, bone marrow extraction also requires a lot of time.

The speed of Zhou Yuan extraction is slow, this is to cause as little discomfort as possible to the donor. According to the regulations, it takes at least 30 minutes for every 500 millilitres of bone marrow blood to be drawn.

Here, Zhou Yuan is taking bone marrow blood one by one, and the hematology department and oncologist are carefully filtering, blood cell separation, counting, and storage.

The demand for hematopoietic stem cells is 2~6x10 (8th power)/kg for allogeneic transplantation, and 0.5~5x10 (8th power)/kg for autologous bone marrow transplantation.

The transplantation between Liu Huimin and her daughter is allogeneic, so a higher number of hematopoietic stem cells are needed.

After about two hours, the bones are complete.

"The operation is complete. Zhou Yuan breathed a sigh of relief.

Liu Huimin's vital signs were very stable, and the transplant went much smoother than she expected.

After the operation, Liu Huimin's side effects will be reduced a lot.

Doctors in hematology and oncology were silent.

The results of bone marrow extraction have spoken for themselves, and Zhou Yuan's bone marrow transplant technology far surpasses the two of them...

Otherwise, this bone marrow extraction would not have gone so smoothly.

"Dr. Zhou, you can send the stem cell suspension over... We continue to process. The hematologist said.

Zhou Yuan nodded, did not shirk, and went to the transplant cabin with the processed stem cell suspension.

A few minutes later, Zhou Yuan and He Jianyi rushed to the outside of the transplant cabin.

In the transplant cabin, Haoyue's face was already swollen, her hands and feet could be clearly seen to be swollen, and her face was extremely ugly, which was much worse than Liu Huimin.

Continuous chemotherapy brought a series of adverse reactions, such as nausea, vomiting, etc., which was very torturous, but in order to survive, Haoyue had to endure it.

"Has the hematopoietic stem cell suspension arrived?" the nurse hurriedly walked over.

Zhou Yuan nodded and handed the suspension to the nurse.

Unlike other surgeries, bone marrow transfusion does not require surgery.

The process is like an infusion, the doctor brings the stem cell suspension, hands it to the nurse, who sends it into the transplant chamber and gives it an intravenous drip into the patient's blood.

Just as the nurse was about to put the stem cell suspension on the infusion stand, Zhou Yuan called out to the nurse.

"Wait, add a 0.2 mm sieve hole to filter when entering. "

The nurse was stunned: "Why?"

"Prevent fat embolism. "

In this way, it is also to increase the survival rate of hematopoietic stem cells after entering Haoyue's body.

The nurse nodded.

"One more point, the last 10ml of each bag of bone marrow blood is left in the infusion tube and discarded, not transfused into the patient. "

Zhou Yuan didn't need to explain too much to the nurse.

With the current state of technology, many substances in the blood cannot be separated.

Hematopoietic stem cells should theoretically be evenly distributed in the stem cell suspension, but some other substances, due to their different qualities, will accumulate in the last part of the suspension.

10ml of bone marrow blood has no effect on Haoyue, but it can remove substances that are not conducive to bone marrow transplantation.

The nurse nodded, "I made a note of it." "

After doing all this, Zhou Yuan breathed a sigh of relief.

However, it does not mean that the bone marrow transplant has been successful.

Once the bone marrow transplant is completed, the patient has the probability of a series of postoperative complications, including bone marrow failure and pancytopenia, accompanied by various infections, bleeding, etc.

However, the infection step should have been avoided because of Zhou Yuan's precise operation.

Late-stage complications are mainly chronic graft-versus-host reactions, immunodeficiency, pulmonary complications, infertility, etc.

These can only depend on the combination of hematopoietic stem cells in Liu Huimin's body and the patient, and Zhou Yuan has no way to do it even if he has a perfect-level bone marrow transplant.

The three days after the operation is a high incidence period, during which various early complications may come to the door, and the three months after surgery is a dangerous period, if the first three days are passed, then although there is a probability of complications in these three months, the risk is much smaller.

One year after the operation, if there is no recurrence, basically this time the bone marrow transplant has been successful, and there will be no problems after that.

Zhou Yuan sighed helplessly.

This operation should have brought down Haoyue's family...

Leukemia is difficult to treat, not only because bone marrow matching is difficult to find, but also because various complications can kill patients, and because of the high cost.

A bone marrow transplant alone costs at least 300,000 yuan for the early treatment, plus the later care and administration, in case of another complication, it can easily be millions. _

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