Start with an emergency physician
Chapter 164
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The hematologist sighed and explained,"We chose peripheral blood stem cell transplantation because it can reduce the incidence and severity of graft-versus-host reaction 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: the onset phase, the accelerated phase, and the blast phase.
The condition is very stable during the onset phase and can last for one to four years. In addition to fatigue, low 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 quickly enter the blast phase. If treatment is continued at this time, the treatment effect and prognosis will be much worse than that of primary acute leukemia, and usually will lead to death...
In other words, if a bone marrow transplant is performed, then a more obvious rejection reaction will occur between the immune active cells in the graft tissue and the immune suppressed, tissue incompatible antigen recipient tissue, namely the graft-versus-host reaction.
"The probability of GVHD (graft-versus-host reaction) is very high, which is the main obstacle to bone marrow transplantation. Even if it is successful, there may be a large number of complications... Without peripheral blood stem cell transplantation, we are not sure to prevent the occurrence of graft-versus-host reaction!" said the oncologist.
Liu Huimin and He Jianyi were also stunned at the same time.
Haoyue's physical condition is very poor now, and his immune system has been basically destroyed. He can't withstand complications such as skin, liver or digestive tract cell necrosis.
The atmosphere in the operating room became heavy.
Zhou Yuan also pondered.
Graft-versus-host reaction is caused by the rejection reaction of the transplanted bone marrow with the patient's body. Although it is inevitable,... a series of postoperative complications can be reduced as much as possible through intraoperative treatment.
With the master-level bone marrow transplantation, maybe you can take a risk and give it a try.
In any case, it is better than letting Haoyue wait for death.
After a moment of silence, Zhou Yuan walked up to Liu Huimin and said,"I am certain that I can complete the bone marrow transplant, but you have already undergone a mobilization injection, and all kinds of physical conditions are preparations for peripheral blood stem cell transplantation."
"Therefore, you may suffer more pain, and since the peripheral blood stem cell transplantation failed to extract hematopoietic stem cells from your peripheral blood, you may need to extract a large amount of bone marrow to collect hematopoietic stem cells.……"
Zhou Yuan had said this, and the rest could only be left to Liu Huimin to choose.
Doctors in the oncology and hematology departments dare not do it 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 reaction.
Zhou Yuan can try his best to make up for these problems through technology. As for various immunodeficiency diseases that will occur in the future, they are inevitable and can only rely on the patients themselves.
Liu Huimin was stunned for a moment and immediately said:"Do a bone marrow transplant!"
She did not hesitate, but was stunned by Zhou Yuan's words.
Does he also know how to do bone marrow transplants...
If it was before, Liu Huimin might, but when one precise and difficult operation after another was perfectly completed in his hands, Liu Huimin subconsciously believed that Zhou Yuan could also perform this operation smoothly.
"Doctor Zhou, my daughter's life... No, I have given my life and my daughter's life! 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 moment, she no longer cared about the image of deputy director, lying on the operating table, she was just a patient, a mother.
Zhou Yuan nodded and looked at He Jianyi.
He Jianyi gave him a trusting look:"Just do it!"
"director……"The doctors in the hematology and oncology departments were all stunned.
"This operation is too dangerous. There is no way to guarantee that the patient will complete the transplant.……"
Zhou Yuan said calmly:"I will also perform the surgery on the patient."
Information about hematopoietic stem cell transplantation flooded his mind.
"Prepare 2.5 NS-500ml mixed heparin 37250."
He Jian nodded and stood next to Zhou Yuan.
This action said it all.
The two doctors from the hematology and oncology departments looked at each other and started preparing immediately without hesitation.
"Donor and patient medical records." Zhou Yuan said as he checked the equipment.
He didn't know the situation of Liu Huimin and his daughter Haoyue.
"The HLA type is consistent, 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 requirements of the operation."The hematologist picked out a few important ones to talk about.
Zhou Yuan nodded and ordered:"Prepare 200 20ml disposable syringes, five No. 16 and No. 9 needles, and five bone punctures."
This operation was performed temporarily, so many surgical instruments were not prepared.
"Anesthesiologist, prepare for epidural anesthesia, and closely monitor blood pressure, heart rate, respiration, and electrocardiogram."
Soon, everything was ready.
Under the shadowless lamp, Liu Huimin's face looked a little old. Looking at the familiar colleagues around her, she sighed and said,"I have performed so many operations on people and have never been afraid. I didn't expect that I would feel cold all over after lying down like this.……"
Zhou Yuan comforted her,"Don't worry, Director Liu, your daughter will be fine."
"Zhou Yuan, I believe you."
Zhou Yuan nodded and looked at He Jianyi,"Teacher, you come to extract the NS+ factor. Hematologists and oncologists, please assist with bone marrow filtration and cell counting. I will take the bone marrow."
After that, Zhou Yuan took a deep breath:"Anesthesiologist, start the anesthesia."
The anesthesiologist was already ready. After hearing the instructions, he quickly completed the epidural anesthesia.
The anesthetic took effect, and Zhou Yuan said:"The operation begins"
"Disposable syringe. Draw heparin NS. Volume 2.5ml."
He Jian nodded, took a 20ml disposable syringe, drew 2.5ml of heparin NS, and handed it to Zhou Yuan.
Zhou Yuan carefully inserted the needle into the bone marrow at the anterior iliac line and sucked the bone marrow into the needle tube.
The 20ml needle tube finally stopped after sucking out 7.5ml of bone marrow.
This is the cumbersome part of bone marrow transplantation. Each time the needle is inserted into the bone marrow, the amount of marrow drawn cannot exceed 10ml, and the ratio of bone marrow blood to NS fluid should be controlled at 3:1, that is, for every 2.5ml of heparin NS, only 7.5ml of bone marrow fluid can be drawn.
After drawing the bone marrow, Zhou Yuan did not directly report it to the doctors in the hematology and oncology departments.
"16-gauge needle."
Next, Zhou Yuan used a 16-gauge needle and a 9-gauge needle to filter the extracted bone marrow.
The hematologist handed over a sterilized plastic bag in which the filtered bone marrow needed to be stored.
But Zhou Yuan shook his head:"No, the bone marrow needs additional processing.……"
"Additional treatment?"The two doctors from the hematology and oncology departments were stunned.
Is there any additional treatment for this step of the bone marrow transplant surgery?_Feilu reminds you: Three things to do when reading - collect, recommend, and share
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