Start From Emergency Doctor

Chapter 167

Zhou Yuan nodded: “It can reduce the graft-versus-host reaction, and it can also reduce the chance of postoperative complications to some extent.”

The hematology and oncology doctors looked at each other.

“Blood cell separator.” Zhou Yuan said.

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

After a while, the bone marrow and blood cells were separated after centrifugation. 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, stopped, and explained: “The donor’s blood type is type A, and the patient’s blood type is type AB. Although type A blood can be delivered to type AB blood, the current The bone marrow blood is supplemented 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 one in two hundred and fifty-sixths, when the patient’s immune system has been destroyed, there is no way to resist the attack of the antibody, which will cause the patient’s red blood cells to be destroyed, which will aggravate the graft. Anti-host reaction.”

He Jianyi and the others were all taken aback.

Zhou Yuan didn’t talk too much nonsense, and said: “Filter the bone marrow blood as I did just now.”

“Establish two venous channels, one for infusion, and the infusion ratio is 2.5 to 3 times the amount of bone marrow blood drawn. The other is for autologous blood to maintain the blood volume and blood pressure of the donor. The needles for both venous channels must be 19 gauge or more .”

He Jianyi immediately opened the venous channel.

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

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

Seeing that the venous channel was opened, Zhou Yuan once again picked up the needle with heparin NS, inserted the needle along the hole of the previous bone puncture, and took out the bone marrow again.

Only 7.5ml of bone marrow blood can be drawn per extraction, and the final volume is about 800ml.

However, what the patient actually needs is only the 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.

This is why we have to prepare two hundred disposable needle tubes.

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

Zhou Yuan’s extraction rate is very slow, in order to cause as little discomfort to the donor as possible. According to regulations, it takes at least 30 minutes for every 500 ml of bone marrow blood to be drawn.

Here Zhou Yuan conducts bone marrow blood extraction one by one, and the hematology department and oncologist carefully perform filtration, blood cell separation, counting, and storage.

The demand for hematopoietic stem cells is 2-6×10 (eighth power)/kg for allogeneic transplantation, and 0.5-5×10 (eighth power)/kg for autologous bone marrow transplantation.

Liu Huimin and her daughter are allogeneic transplants, so more hematopoietic stem cells are needed.

After about two hours, the bone marrow aspiration was completed.(Read more @ wuxiax.com)

“The operation is complete~ˇ.” Zhou Yuan breathed a sigh of relief.

Liu Huimin’s vital signs are very stable, and the bone marrow transplantation is much smoother than I thought.

After surgery, Liu Huimin’s side effects will also be reduced a lot.

The doctors in the department of hematology and oncology were silent.

The results of bone marrow extraction have explained everything, Zhou Yuan’s bone marrow transplantation technology is far superior to the two of them…

Otherwise, this bone marrow extraction will not be so smooth.

“Doctor Zhou, you can send the stem cell suspension… we will continue processing.” said the hematologist.

Zhou Yuan nodded and did not refuse, and took the processed stem cell suspension to the transplant chamber.

A few minutes later, Zhou Yuan and He Jianyi arrived outside the transplant cabin.

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

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

“Has the hematopoietic stem cell suspension arrived?” The nurse hurried over.

Zhou Yuan nodded and handed the suspension to the nurse.

Bone marrow transfusion is different from other operations and does not require surgery.

This process is like an infusion. After the doctor sends the stem cell suspension, it is handed over to the nurse, and the nurse will send it into the transplant chamber, and put it into the patient’s blood by intravenous drip.

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

“Wait, add a millimeter sieve to filter the input.”

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 thing, the last 10ml of each bag of bone marrow blood is left in the infusion tube and discarded. Do not enter the patient’s body.”

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

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

In theory, hematopoietic stem cells should be evenly distributed in the stem cell suspension, but some other substances, because of 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 wrote it down.”

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 transplantation is completed, the patient may have a series of postoperative complications. Early complications include bone marrow failure and pancytopenia, accompanied by various infections, bleeding and so on.

However, this step of infection should be avoided because of Zhou Yuan’s precise operation.

Late complications are mainly chronic graft-versus-host reaction, immunodeficiency, pulmonary comorbidities, infertility and so on.

All of these can only be seen in the combination of the hematopoietic stem cells in Liu Huimin (Nuo’s Zhao) and the patient. Even if Zhou Yuan has a perfect bone marrow transplant, he can’t help it.

The three days after the operation is a high-incidence period. During this period, various early complications may come to the door. The three months after the operation is a dangerous period. If the first three days are passed, there is a possibility of complications during these three months. Disease, but the risk is much smaller.

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

Zhou Yuan sighed helplessly.

This operation should have brought down the Haoyue family…

Leukemia is difficult to treat, not only is it difficult to find the type of bone marrow, various complications will kill the patient, but also the high cost.

A bone marrow transplant operation requires at least 300,000 yuan for the initial treatment alone, plus the later nursing and medication, in case there is another complication, it will cost millions at every turn. .