Start From Emergency Doctor

Chapter 166

The oncology doctor was a little bit hesitant.

The hematologist sighed and explained: “We choose peripheral blood stem cell transplantation. What we are interested in is that the incidence and severity of graft-versus-host reaction will be greatly reduced after surgery… But, your daughter has chronic myeloid leukemia… …”

Zhou Yuan frowned.

Chronic myelogenous leukemia is a type of leukemia, which has three stages of development: onset, accelerated, and blast phase.

During the onset period, the condition is very stable and can last for one to four years. Except for fatigue, low fever and other manifestations of hypermetabolism, there is only one clinical manifestation of splenomegaly.

Accelerators will quickly show more symptoms such as anemia, and then quickly reach the blast phase. If treatment is carried out at this time, the treatment effect and prognosis will be much worse than that of primary acute leukemia, and usually lead to death…

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

“GVHD (graft-versus-host reaction) is very likely to occur. This is the main obstacle to bone marrow transplantation. Even if it succeeds, there may be a large number of complications… Without peripheral blood stem cell transplantation, we are not sure to prevent the transplant. Anti-host reaction appears!” The oncologist said.

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

Haoyue’s current physical condition is very poor, and the immune system of the whole body is basically destroyed, and she can’t withstand the complications of skin, liver or digestive tract cell necrosis.

The atmosphere in the operating room became heavy.

Zhou Yuan also thought about it.

The graft-versus-host reaction is caused by rejection of the transplanted bone marrow and 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-class bone marrow transplantation technique, it may be possible to take a risk.

No matter what, it’s better than letting Haoyue wait for death.

After a moment of silence, Zhou Yuan walked up to Liu Huimin and said: “I have a certain degree of certainty that bone marrow transplantation can be completed, but you have been injected with mobilizer before, and the various conditions of your body are prepared for peripheral blood stem cell transplantation.

“Therefore, you may be more painful, and since peripheral blood stem cell transplantation fails 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…”

With Zhou Yuan’s words here, the rest can 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 use technology to make up for these problems as much as possible. As for various immunodeficiency diseases in the future, they will inevitably arise, and they can only rely on the patients themselves.

Liu Huimin was taken aback 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 might still be suspicious, but when the precise and difficult operations were completed perfectly in his hands, Liu Huimin subconsciously believed that Zhou Yuan could also complete this operation smoothly.(Read more @ wuxiax.com)

“Doctor Zhou, my daughter’s life…no, my daughter’s life and I are in your hands! You can take as much bone marrow as you can, and you can give mine to her, you must save her!”

Liu Huimin’s voice was a little choked.

At this time, she had ignored 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 go!”

“Director…” The doctors in the Department of Hematology and Oncology were all taken aback.

“This operation is too dangerous. For bone marrow transplantation, there is no way to guarantee that the patient will complete the transplant…”

Zhou Yuan said indifferently: “I also do the surgery on the patient’s side.”

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

“Prepare a NS-500ml mixed heparin 37250.”

He Jian nodded and stood beside Zhou Yuan.

This action has it all.

The two doctors in the department of hematology and oncology looked at each other, no longer hesitating, and immediately began to prepare.

“Donor, patient’s medical record.” Zhou Yuan said as he checked the equipment.

He did not understand the situation of Liu Huimin and her daughter Haoyue.

“The HLA matching is the same. The blood type of the donor is type A, the blood type of the patient is type AB, and the patient’s weight is 47kg. Other indicators meet the requirements of the operation.” The hematologist picked several important points.

Zhou Yuan nodded, and then ordered: “Prepare two hundred 20ml disposable syringes, five No. 16 and No. 9 needles, and five for bone puncture.”

This operation was performed temporarily, so many surgical instruments were not prepared.

“The anesthesiologist, preparing to perform epidural anesthesia, closely monitor the four physical data of blood pressure, heart rate, respiration and electrocardiogram.”

Soon, everything is ready.

Under the shadowless lamp, Liu Huimin’s face was a bit old. He looked at the familiar colleagues around him, sighed, and said, “I have performed so many operations on people. I have never been afraid. I never thought I would come up and lie down like this once. cold……”

Zhou Yuan comforted: “Dr. 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 are here for the extraction of NS+ heparin, hematology and oncologists, please help with bone marrow filtration and cell count, I will take bone marrow.”

After speaking, Zhou Yuan took a deep breath 907: “Anesthesiologist, start anesthesia.”

The anesthesiologist was already prepared, and after hearing the instructions, he quickly completed the epidural anesthesia.

The anesthetic took effect, Zhou Yuan said: “The operation begins.”

“Disposable syringe. Withdraw heparin NS. Volume ml.”

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

Zhou Yuan carefully advanced the needle through the iliac and sucked the bone marrow into the needle tube.

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

This is the cumbersome part of bone marrow transplantation. Each time the needle is inserted into the bone to remove the marrow, 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, each tube of heparin NS, only Can add 7.5ml of bone marrow fluid.

After the bone marrow was drawn, Zhou Yuan did not directly refer to the doctors in the department of hematology and oncology.

“No. 16 needle.”

Next, Zhou Yuan used 16-gauge needles and 9-gauge needles to filter the obtained bone marrow.

The doctor of the hematology department handed over the sterilized plastic bag. The filtered bone marrow needs to be stored in it.

But Zhou Yuan shook his head: “No, additional treatment is needed for the bone marrow…”

“Extra treatment?” The two doctors in the Department of Hematology and Oncology were stunned.

Is there any additional treatment for this step of bone marrow transplantation? .