When I received a call from the successful initial match of hematopoietic stem cell donation, I knew that many people may be unlucky.
As a cub with poor vascular conditions to the nurses' station of the famous school hospital, every time I went to draw blood hanging needles, my "unpopularity" was second only to that of Mango Mille-feuilles on night shift (because "mang" harmonic "busy").
So much so that after receiving the call, my brain was in a mess, and I said a sentence that may never have appeared in the first match success notice: "I... The vascular condition may not be very good, and you will have to wait a little while. ”
The teacher across the phone, perhaps preparing a bunch of responses to questions about identity confidentiality and the donation process, was silent for several seconds after hearing my answer. In the end, the reply I received was: "It's okay, you still need high-resolution testing and physical examination to confirm whether you can donate, just ask your wishes first." ”
I am indeed not the donor of choice. In the case of similar sites, male, young and blood group match is the preferred factor, and finally selected to my estimation is "everyone can't do it, make it up".
The teacher of the bone marrow bank said
The other party is a 19-year-old handsome guy
Half a month later, I waited for a call for a high-resolution test.
When the initial match only needs to match 6 loci, after 5 (even relax the conditions) will be called to do high-resolution detection; and high resolution to do 10 loci, 10 loci all coincide or at least 8 loci to pass.
The so-called site coincidence refers to whether the main sites in the human leukocyte antigen (HLA) allele are the same.
People with a matching number of loci may be selected as lucky donors after assessing their health status, family history, and other factors. Of course, as other "substitutes", the bone marrow bank will also keep in touch with them to avoid the lucky players from being unable to donate due to unexpected reasons.
Schematic diagram of hematopoietic stem cell transplantation | Tencent Medical Code
The high-resolution test was at a blood donation point, and when I went in, there were three or three blood donors inside. The teacher of the bone marrow bank came with a bunch of test tubes, followed by a huge sign. During this period, I have been trying to secretly shoot the consent form, planning to send a circle of friends, sneaking around for half a day and then learning that I want to bring back a version of the bottom, if I knew it earlier, I didn't have to work so hard.
When the nurse sister gently called my name, I knew that the first unlucky child she had come! The little sister looked at me with a hard look at her and thought I was nervous: "It's okay, we'll smoke 10 ml." ”
After 10 minutes, she looked at the neatly glued tape on my arm, but left two empty test tubes singing in a cold silence.
"Or the wrist?" I tried to negotiate.
"No, my wrist hurts." The little sister changed the needle and continued to explore the vein that was completely invisible, "I must draw it out today!" ”
This spirit of not abandoning and not giving up is probably the hope of the nation.
As she continued to explore, the little sister said to herself, "This seems to be... But such a drum is a bit like a nerve... Whatever you want to try! ”
I don't think I should be here.
After some "needle in-tinkering-out-needle-needle", a touch of cordial red suddenly appeared in the hose, and both of them breathed a sigh of relief. Then I heard the crowd of onlookers behind me at some point: "Enter! Got in! ”
Good guys, more thrilled than a World Cup goal.
But the story has only just begun, and the drops of red liquid in the test tube show that things are abnormal, and the long wait makes the embarrassment and anxiety spread. I trembled and said, "Or... Let's talk? ”
The bone marrow library teacher standing on the side seemed to have suddenly unlocked the laughing hole, and after a "hahahaha" and then said to me: "When you donate like this, you mostly need to have a deep vein catheter, that is, a knife in the thigh, put a tube in, count it as a small operation." ”
After finishing a high-resolution test that shouldn't have been so long, I ran away in the wilderness, and my brain went blank and I sat back on the subway.
It turned out that my legs had conspired to run away. But it is impossible to run, and it is impossible to quit the drum, after all, the bone marrow bank teacher and I said that the other party is a 19-year-old handsome guy. Although he only knew this, he was already my brother, dear.
Even now I want to be quiet, and my arm is also thinking.
The medical examination is a more enjoyable journey
A few weeks later, I received a phone notification that the high-resolution test had passed. After hanging up the phone, the first thing I did as a medical student was to flip through the chapter on deep vein catheterization and memorize the operation from beginning to end.
The second thing is to check the physical examination criteria for stem cell donation. Blood and imaging tests are similar to the criteria for entry physical examinations, but there are additional requirements for donor body mass index (BMI) and fatty liver: one must be 19, and the other is almost impossible.
Fatty liver is not worried, but if there is a need to delay donation, during which time will be gently urged to run and exercise. As for the BMI requirements, since I enjoyed two weeks of snacking before the check-up, I intend to stand on the scale with confidence and enjoy the passing results.
Careless, the height measurement of the physical examination does not take off the shoes! But fortunately, I have a coat, two centimeters more high and two pounds more coat to offset each other, bringing me no less happiness than low scores floating across the passing line.
Immersed in great joy, I didn't realize another serious problem until I sat down at the blood-pumping table with a basin of tubes in my arms.
"Put your arm here." In front of me is a teacher who is experienced at first glance.
"My... possible...... Blood vessels are harder, so you should be mentally prepared. ”
"I'll see, what's this?" The teacher flexibly knotted the strap. Sure enough, as soon as the hero struck, he knew whether there was one or not, that is, he was really tight.
"Yo, it's not too obvious!" The teacher echoed, while quickly slapping his arm with his hand, and after a dazzling palm, "You see, isn't this coming out!" "Only to see that on the elbow that had become reddish due to the palm wind sweeping, there was a bulge that did exist although the color could not be seen, and there was!
Under the great admiration, a wave of pride quietly emerged - my blood vessel is not so unbearable!
Overall, the medical examination is a more enjoyable journey. The three-story red-walled bungalow and the right temperature, the environment, and the two buns and a bowl of porridge provided at the end pushed this pleasure to another level - I must be the bird that eats the dead.
I have been certified as "seriously ill" by many parties
For the first time in my life, I became the subject of the conference
The next step is to wait for the physical examination to pass, and if there is no accident, things are basically nailed down. When I received the call with the date set, I put down the phone and went to the education office teacher to ask for leave. The teachers were also very happy, and within a few minutes they finalized various arrangements, and even set up a group without me - I was far more than the one working hard for my "brother".
In the evening, a small friend carefully asked me: "Have you been under more pressure lately?" Or are you in a bad mood? ”
"Nothing? What's up? ”
It turned out that when I was studying the time for leave, an enthusiastic teacher rushed into the classroom and said, "You guys have to be nice to XXX lately!" "So everyone was wondering if I was seriously ill.
Next, I sent WeChat to my mother, and I needed her to ask the unit for leave to accompany the bed. But the low-key she did not want to publicize the matter: "Those days are not good to ask for leave, I said you have to do surgery." "It seems that I have a serious illness again.
I was notified to sign the last consent form when I was certified as a serious illness. Previously, high-resolution tests and physical examinations had to sign specific consent forms, which were brought by the teachers of the bone marrow bank. I thought it was the same this time, and as soon as I entered the conference room - wow, so many leaders!
The first time I attended a conference on my theme, it wasn't an expulsion seminar, and I felt like I had earned it. In addition to signing consent forms and routine greetings, I received a red-headed document and three requests. The document was a leave notice to the school, asking for a month of rest after being discharged from the hospital, and I remember that there was a sentence on it "Please give XXX vacation", super cool. The three requirements are: do not pet cats and dogs, try not to catch a cold, and pay attention to ethical requirements.
The reason is that if the rabies vaccine is needed after being scratched and bitten by a cat or dog, donation must be delayed, and at this time the patient has entered the transplant warehouse for irreversible myelination treatment (a large dose of chemotherapy), and if the date needs to be adjusted at this time, it is in the pit brother. The same goes for colds.
Probably because I watched too many strange TV dramas, the ethical requirements I thought were afraid of en tu bao and so on. The result is that I am afraid that the next generation or two will collide with the spark of love, and it belongs to the marriage of close relatives.
The highest form of signature confirmation - signing ceremony 丨 Author courtesy of the image
After signing, I spent another week on leave and dealing with pre-hospital matters. After receiving the high-speed train to meet the ice cream mother, I was admitted to the hospital!
The cost of "one pot end" hematopoietic stem cells
It's a lot of muscle aches
Hospitalization is not in the hematology department but in the special needs ward, and the two beds are for the donor and the accompanying bed family. The room was spacious and the view was nice. I was probably admitted to the most expensive ward I could ever have in my life.
The most luxurious ward in this life 丨 Author courtesy of the author
After admission, he signed a row of consent forms, and then went downstairs to do a spleen B ultrasound - in order to compare with the activation of hematopoiesis. After I tied the green wrist strap, the nurse sister came with the guy who was drawing blood.
Because the elbow should be left intact for collection after a few days, the blood drawn every morning in these days is drawn on the back of the hand.
"Little sister, sit!" I hooked a chair.
"No, just two tubes!" Nurse sister Ma Li refused. Until the tape was tied and the poison was eliminated, "You blood vessel...", the back of my hand was full of dark red mesh capillary lines, and the veins that should have shown their true face were still holding the pipa and half-covering their faces, very shy.
After some tossing and turning, the blood draw was finally over, and then began to prepare to poke the needle , subcutaneous injection of colony stimulators (commonly known as "mobilizers" ) , in order to wake up the sleeping hematopoietic stem cells in the bone marrow, let them run into the bloodstream, and then take advantage of the fact that they are not ready for a pot. The side reaction is naturally there, after all, it is a lack of virtue to tell stem cells to get up, and it is reasonable for them to get up a little. But it's just getting up, and when they are taken away by a pot, everything will be fine.
After injecting the mobilizer, the white blood cells will jump six or seven times. 丨 Courtesy of the author
So my hospital schedule was: five o'clock blood draw, six o'clock breakfast, eight o'clock poke needles, eleven o'clock lunch, two o'clock snacks, three o'clock poke needles, four o'clock dinner. I was either eating or waiting for a meal. The rest of the time is free to move, but out of the hospital to ask for leave, so I looked at the cells to get up angry, carrying my mother yo-yo to take a costume photo!
And the mother and two people eat a luxurious sick meal that can not be eliminated丨 the author provided the picture
When I was crouching on a prop stone to disguise the mermaid, suddenly a strong sense of powerlessness struck from the limbs and skeletons, as if the blue deep sea where the mermaid lived was suddenly covered with gutter oil, and the mermaids swam alive for their lives.
Yes, the next feeling is pain—the muscle aches after a marathon. But the next day, I felt that I was running this marathon with my face. A hot knowledge - a person's face has 48 muscles, and when the muscles begin to hurt, none of them can escape.
After that, I didn't have the courage to go out on the waves again, and as soon as I put on the hospital gown, I gained self-role recognition, and began to circle the corridor with other patients on the same floor.
The collection hospital is famous for its neurology department, and the neighbors in the special needs ward are mostly recovering patients after brain surgery, and when I walked around in circles, a flat-headed sister would smile and greet me every time she wiped her body: "Hello!" Meet for the first time! ”
But after walking around three or four times, I couldn't walk around and couldn't meet my sister for the first time, so I slipped back into the room. The nurse in the next ward pushed a wheelchair through the door. The old man in the wheelchair is in his eighties, has experienced a very serious cerebral hemorrhage, and has lived here for two years. He laughs when he sees people, but he can't talk or remember things.
I dismantled a bouquet of flowers and taught the old man to count 123, and when the number was right, I gave him the flowers, and an hour later the old man happily pushed back to the ward with his full of flowers. I also had a fever because I was playing too much, and I was pressed back to bed by the head nurse to catch up on sleep.
A few days of mobilization were spent in eating, waiting for meals, teasing the old man, and greeting all kinds of friends to visit. Unconsciously, it ushered in the day of "one pot of stem cells".
For the sake of the "rush" of the brother
My two hands were swollen into "pig's trotters"
It was a tempting porridge of egg-peeled vegetables that morning, but I didn't dare to take a bite. Only because I was eagerly told by the seniors before that I could not get out of bed offline when going to the toilet during the collection, I had to use a urinal. It sounded awkward, so I decided to stop hydration.
The last dose of mobilizer is not a subcutaneous needle but an ass needle because it has to work quickly. It didn't hurt, but after the end, my mother imitated a heavy punch when poking the needle, which still made me laugh.
Next, I was pulled into a large conference room, and many teachers came from the city and district Red Cross Societies, schools, and internship hospitals. While thanking everyone for their care, I was really nervous, I didn't expect to make such a big move, but I just needed to easily collect flowers and take pictures.
Looking back at the bouquet full of flowers, I was still on the same screen with so many flowers for the first time, and it was also the first time I knew that I was allergic to lilies. So there may be tears in my eyes on various promotional photos, except for the element of gratitude, a large part of the reason is that I was sneezed.
Endured the sneezing back to the ward to change the hospital uniform, and then went downstairs to shoot the B ultrasound, and found that the spleen was enlarged by about 1/3, and the undercostal can be touched. But I already knew, after all, last night I had my own palpation of the edge of my spleen overnight.
Coming to the hematology collection room, The nurse Xiao Yang, who is specially responsible for the collection, has been debugging the machine inside. There was also a hospital bed inside, which was my collection bed for the day.
Sleep in a different place, I'm good at this job. In fact, at this time, each donor is probably looking forward to the collection. After all, after the stem cells are taken away by a pot, those side reactions will no longer exist.
Connected to the circulation machine are two indwelling soft needles and tee tubes poking at the elbow. The poke went unexpectedly well, and before I could worry about whether the veins that had been cultivated for so long would not be able to fight, I had been told not to move.
Little Sister Yang was full of confidence: "If it goes well, it will be over in two or three hours." ”
The Red Cross teacher poured out the illusion on the side: "She should have been a little longer." The machine made a dripping sound, as if in agreement.
"The flow rate is not enough, come and pinch the ball, put it in and out." I had a pink star planet stuffed in my hand. Later, the star planet became the material for various pushes, but at the time it was really my nightmare.
This star planet was pinched by me all day. 丨 Courtesy of the author
Pinching the ball didn't help, and the machine went from a low-velocity drip alarm to a loud roar of gear rotation, and then stopped—the flow rate was too low to keep up with the machine's rotation, so it stopped.
"I'll give you a change of left and right hands!" Then change the tube and restart the machine. Soon, the machine issued a low flow rate alarm sound of "Didi Didi".
"Pinch!" I did. The roar of the machine was like the purring sound of a cat standing on the ground in the house—the machine stopped again.
The Pink Star Planet switched from my left hand to my right hand and back to my left hand, and there were two re-pokes in the middle, and the machine was constantly circulating in "Drip" and "Purr". If the machine can talk, it will probably already curse people - we are not happy to restart it!
Take a group photo with the collection machine that will "Didi" and "Whine" 丨 Author courtesy of the author
At this time I felt as if the lilies of the morning were still in sight, at least I had similar signs. A second before I decided to cry, the Red Society teacher sighed: "The little girl is really strong, last time there was a girl who was older than you, and she couldn't get up at the flow rate, and she cried so pitifully." "Okay, I'm holding back.
At this point I suddenly realized what I had forgotten, deep vein catheterization?! Several other people in the room obviously thought of this too, and the Red Society teacher went out for a while and came back and said, "The anesthesiology department said that no one could send manpower, and no one did it today." "Got away with it, but then you have to toss it yourself."
Needless to say, small surgery is small surgery, and I thought it was better to have a good time.
The director of the hematology department also came around and asked me bitterly, "Why do you have to agree to such a little girl?" "It's not a coincidence, my brother's fate is not good to catch up with me, so no one should abandon anyone."
"If only I didn't do it!" Sister Yang hung a bag of salt water with anticoagulant on it, and used other liquids to ensure the flow rate. Seeing the situation, I was busy asking my mother to buy a urinal and came back, and began to regret that I did not have close contact with the porridge in the morning.
After this time, the collection finally proceeded slowly, although it was necessary to change hands or pinch the ball after a while. At this time, more than half of the expected two or three hours have passed, and I am afraid that it is a protracted battle.
At noon the doctor at the patient's hospital came to pick up the sample and brought my brother a gift and a letter. Looking at the progress of only 1/3, I was embarrassed but polite to recommend her to go around the neighborhood, and when I opened my mouth, I found that it was a fellow.
The doctor said: "You are not easy, he is not easy, after going to college to become a soldier, they are suddenly sick in training, pancreatitis when they come to our hospital, they have to multi-organ failure, it is difficult to rescue back." The back is still quite smooth, and the matching physical examination has not taken a detour. My werewolf, a medical student, began to blow himself up: "Pancreatitis? Then he must have used pemenxatose... He's acute lymphoblastic (acute lymphoblastic leukemia), right? ”
"That's all right! How do you know? ”
I smiled slightly, this is my final essay from last semester.
However, as soon as this statement came out, for the next two years, my mother had been mistakenly thinking that my brother was Jilin.com.
In the afternoon, Sister Yang said that the anticoagulant hit a lot, afraid of cramping to give me some calcium. My eyes "Boom! The ground stared like a brass bell. Listening to the previous donor mysteriously mentioned that when calcium is played, there will be a feeling of glory and bliss, and I am full of expectations. After ten minutes I wondered if I was not ready, and when I looked down, I had been pushing for a while, and there was no bliss, but the machine was already bliss before it stopped.
I worked hard until four o'clock in the afternoon, and finally completed today's task before the inspection department left work, which took seven hours. Because I still had to check the number of cells, the indwelling needle was still inserted in both arms, and I tentatively bent my arms - there was no resistance, but my two super small hands, which have always been known as chicken feet, were now swollen into pig's trotters, and they looked a lot white and tender.
Little Sister Yang handed me the blood bag and said that she could take a picture, but after lying down for a day and having a haircut, I humbly refused. Unlike warm whole blood, this stem cell hung on the machine for a day early in the cold, I don't know if it is a psychological effect, I think it is a little thicker than whole blood, a little raspberry juice feeling.
After lying down for a day, getting up a little dizzy, the nurse uncle pushed the wheelchair, and after thanking Sister Yang, I was wheeled out of the collection room. I was a little excited about my first wheelchair ride, but when the line of sight in the elevator was only level with a bunch of butts, the excitement was over.
After returning to the ward, I began to drink pigeon soup while grabbing a pen with a white and tender "pig's trotter" to write back to my brother, thinking that if there was a collection the next day, the doctor could bring it back. Although I lay down for a day, I was still sleepy early, so I didn't go to the corridor and the young lady of pingtou to circle around, only when the old man was pushed over to see the wall flowers.
At ten o'clock, the nurse came in and said that the cells were enough to pull out the needle, and I seemed to run away from the tight curse of the indwelling needle, and I wanted to get out of bed and dance, but I was still ruthlessly pressed back to the bed.
The next morning, the two "pig's trotters" had subsided, which did not increase the difficulty of the last day's blood draw. When I was about to leave the hospital, a small friend came to me, and the nurse pushed the old man to the door and asked, "How many little beauties are there?" The old man trembled and stretched out his hand to compare three, and the nurse was trying to correct it, when I suddenly saw the old mother who was looking down to collect things with a shy smile at the corner of her mouth. I was busy giving Uncle a thumbs up and hurting my Grandpa.
Today, two years later, everything is fine
After being discharged from the hospital, the teacher of the internship hospital helped to find a room, and also booked a meal in the nutrition department, and ate the soybean stewed pig's trotters for two consecutive days, I realized that something was not right, and I learned that the teachers discussed it, thinking that donating stem cells may be similar to giving birth to a child, and the meal is ordered according to the standard of the confinement meal.
The next few days is the power outage protection at any time, maybe one second before I was still bouncing around, the next second the low power back to the pillow upside down to sleep, wake up to walk around in good spirits, but did not dare to go far.
Soon after receiving the school's proposed push, all kinds of praise made my old face blush, and the description of the collection had a sentence "After a day's collection, her hands were tied into a honeycomb" - this collection machine is a Rong Ma ma!
However, it seems that the collection of peripheral blood hematopoietic stem cells by non-relatives is not a hot knowledge, and most people are still solidified in the concept of "donating bone marrow to poke bone marrow". In fact, the whole process is like an extended version of blood donation, and the general vascular condition only takes two or three hours - even if it is seven hours, it is one more urinal.
As for the recovery period, although the school gave a month's leave, the hematopoietic function generally returned to normal in two weeks, and there was even a god who went out to play ball in the morning after donating money in the afternoon, but later used as a negative teaching material by the Red Cross teacher. At least from my personal experience, starting from the third week, I did not need to rest one floor and two floors to breathe, but it was still quite beneficial. It's just that the weekly review of blood routines still pains the doctors in the community hospital. Later I told them that as long as they were tied tightly enough and the needles were thick enough, there was no blood that could not be drawn.
Today, hematopoietic stem cell donation has been more than two years old, except for the occasional appearance in the college brochure, or by various leaders to comfort a sentence "How is the body now?" I am already an ordinary graduate student of "psychiatry" who has had a novel experience.
The Red Cross gave each donor a red certificate and a picture courtesy of the author
Occasionally I think about my "twin brother" who is a few years apart, and although I don't have the courage to apply for a face base, I hope he is all right. Maybe he's already glowing somewhere! Maybe he's one of the various volunteer styles I've seen!
Doctor reviews
Yang Chen | Attending physician, Department of Hematology, Peking Union Medical College Hospital
Thanks to the author's witty and humorous writing detailing the personal experience of peripheral blood hematopoietic stem cell donation, as a hematologist, I was also deeply touched to see this article.
In the past, you may have heard the term "bone marrow transplantation" relatively much, because more than ten years ago, the hematopoietic stem cell transplantation technology was not advanced enough, and only bone marrow-derived hematopoietic stem cell transplantation could be carried out, which meant that the donor needed to donate about 800 ml of bone marrow. Bone marrow collection requires the donor to enter the operating room for lumbar anesthesia, and punctures are more than 30 times at the regular bone puncture site of the buttocks, and only no more than 25 ml of bone marrow fluid can be collected at each site. 3 weeks before the collection, it is also necessary to prepare blood in advance, that is, the donor donates 400 ml of blood to himself in advance, and 400 ml of whole blood will be returned to the transfusion during the bone marrow collection to avoid hemorrhagic shock too quickly.
Thanks to the rapid development of hematopoietic stem cell transplantation technology, healthy donors no longer need to "poke the bone marrow", but only need to donate peripheral blood hematopoietic stem cells according to the process described in the article, as the author describes, it is more like an extended version of ordinary blood donation.
Methods for collecting hematopoietic stem cells | Tencent Medical Code
Popular science, transplanted hematopoietic stem cells can be derived from: partially compatible relative donors, such as siblings; semi-conjugated donors, that is, the patient's parents or children; umbilical cord blood, Chinese hematopoietic stem cell donor database (referred to as the Chinese bone marrow bank) in the non-related donor, also known as unrelated donors. Patients and donors require rigorous human leukocyte antigen (HLA) matching, even if the blood group is incompatible but the HLA match is compatible, they can be used as a donor.
The China Bone Marrow Bank is composed of caring volunteers who voluntarily donate peripheral blood stem cells like the author, thus forming a large-scale national bank, and many patients with malignant blood diseases have been reborn through hematopoietic stem cell transplantation from unrelated donors. As the author says, the process may be magical and great, like having a "blood-related" relative.
Sharing personal experience does not constitute a diagnosis and treatment recommendation, can not replace the doctor's individual judgment of a specific patient, if you need to go to a regular hospital.
Author: Bu Xi
Editors: Yuan Qiyang, Li Xiaoqiu