Hematopoietic stem cells from Shijiazhuang to Beijing:
A relay of life under the epidemic
Li Yunfei lay on his back on the bed, covered with a thin quilt, and his nose blew up the mask.
He couldn't move, and a needle was inserted into the center of the elbow of both arms. The needle was thick, and the blood in the body flowed out along the needle and the tube, leading to a machine on the side of the bed.
The machine is extracting hematopoietic stem cells from the blood.
In the early morning of January 11, Li Yunfei from Handan entered the blood collection room of the Third Hospital of Hebei Medical University and donated a hematopoietic stem cell suspension to a Beijing patient with a blood disease.
According to the plan, this bag of suspension will leave Shijiazhuang on the same day, arrive in Beijing, and be transplanted into the patient's body. Since January 1, the patient has completely lost his immune hematopoietic function, which means that every additional second of delay, The patients are all hanging by a thread.
However, affected by the local epidemic, on the afternoon of January 5, Shijiazhuang City announced the implementation of closed-loop control on all communities and rural areas in the city.
Traffic control will be implemented on January 6, suspension of high-speed rail and flights, and high-speed entrances closed...
During the closed-loop control of the city, how to complete the delivery on time and safely?
A few hours before the collection, the Red Cross of Hebei Province, the Traffic Management Bureau of the Public Security Department of Hebei Province, the Traffic Police Brigade of the Traffic Management Bureau, the Third Hospital of Hebei Medical University, the Hebei Branch of the China Marrow Bank, and the Shijiazhuang Red Cross have all started operations and quickly set up Starting from the high-speed green passages in Shijiazhuang City and Hebei Province, a life-and-death relay to Beijing is about to begin.
If you can’t transplant on time, people will easily be gone
Li Yunfei is 47 years old, wearing glasses, dark skin, and shaved a short head.
On January 11, when he and his wife arrived at the Third Hospital of Hebei Medical University, it was not yet seven in the morning.
Before dawn, the hospital building was shrouded in the orange light of street lamps.
Li Yunfei first went to the ward for a pre-check, and then went to the hospital cafeteria and ordered two eggs, a bowl of porridge, and a small portion of vegetables.
It took ten minutes to finish eating, and the time was tight, and immediately entered the blood collection room.
An electronic screen is hung on the ceiling, displaying a room temperature of 25 degrees; when the time on the screen reaches 7:40, the collection starts.
Li Yunfei took off his coat and only wore a short sleeve from the Chinese Marrow Bank volunteers. He lay flat on the bed and covered the quilt.
Doctor Pan Hongjuan deployed a blood cell separator at the bedside.
The nurse tightened the tourniquet above Li Yunfei's elbows and called him to clenched fists.
After wiping and disinfection, two needles with an outer diameter of about 1.6 mm were punctured into Li Yunfei's elbow vein.
At 7:48, the sky outside the window gradually brightened, and the blood cell separator began to operate normally.
On November 9, 2020, Li Yunfei received a call from Zhang Xinjun from the Hebei Branch of China Bone Marrow Bank (hereinafter referred to as "Hebei Branch").
The latter told him that his blood sample in the bone marrow bank was matched with a patient in Beijing, and asked him if he was willing to donate it.
"I immediately agreed. I waited for this opportunity for almost ten years." Li Yunfei said that he was a soldier and went to the General Affairs Department of a hospital in Guantao County, Handan City to do logistics support after he was discharged.
In July 2011, the county Red Cross and the hospital jointly organized a publicity campaign for donating hematopoietic stem cells.
Li Yunfei looked at the information and was very moved. “I spent more than ten years in the hospital and saw too many life and death separations. I thought that donating this thing might have a chance to save lives.” So he took blood and put it into the warehouse on the same day.
The match between donors and recipients is purely a matter of probability.
"The capacity of the Hebei sub-library is more than 150,000. Some people have sampled and put into the library since the establishment of the library in 2003. Until now, they have not been matched successfully. Some people have been matched within two months." Zhang Xinjun said.
On December 10, 2020, Handan Red Cross arranged for Li Yunfei to undergo further medical examinations.
The results showed that Li Yunfei's blood quality was not up to standard and was chylo-like, that is, the blood had high viscosity and high fat content, making it difficult to collect and extract hematopoietic stem cells.
Li Yunfei started to eat lightly, smoke-free alcohol, consume less oil and salt, and focus on fruits and vegetables for his three meals.
Zhang Xinjun explained that there is no harm in eating high-protein and low-fat meats such as beef and chicken in moderation.
However, Li Yunfei was afraid of delays. Before the donation was completed, he had only given two quits and ate some shrimps.
Eat less eggs, remove the yolk and eat only the egg whites.
Li Yunfei said that it doesn't matter if you eat, but the uncomfortable thing is that the smoking is broken.
He has 30 years of smoking experience, and when he smokes a lot, he can smoke one pack a day.
When the cigarette is cut off, the whole body is sluggish, and the addiction can only be transferred by eating melon seeds.
In addition to diet, exercise should also keep up.
He had a treadmill at home, and he ran for an hour every day.
This persisted for half a month, and at the end of December, the second physical examination was conducted, and Li Yunfei's blood quality reached the standard.
The Hebei Branch also negotiated with the attending physician of the donated patient to set the date of collection and transplantation of hematopoietic stem cells on January 11, 2021.
On January 3, Shijiazhuang added a new local case of new coronary pneumonia.
In the next two days, the cases showed an increasing state.
On the afternoon of January 5, Shijiazhuang City announced the implementation of closed-loop control over all communities and rural areas in the city.
Traffic control will be implemented on January 6, suspension of high-speed rail, flights, and high-speed entrances.
Also on January 6, Li Yunfei and his wife rushed to Shijiazhuang from Handan as scheduled.
At that time, Shijiazhuang was in a state of "only entry but no exit".
Zhang Xinjun arranged them into a hotel near the hospital, and ordered meals from the restaurant at the door every day.
Zhang Xinjun introduced that in order to cooperate with the transplantation, on January 1, 2021, patients in Beijing will begin to undergo "myeloablative" treatment, which is to kill the inadequate hematopoietic stem cells in their bodies and wait for new hematopoietic stem cells to be implanted in the body-this acceptance The transplanted patient was nearly 60 years old, suffering from a serious blood disease and disability of the hematopoietic system.
Therefore, everyone faces an extremely dangerous state: marrow ablution is a path that has no return. The patient has completely lost the immune and hematopoietic function and can only be admitted to the laminar flow ward of the hospital, waiting for transplantation in a sterile environment.
At that time, the patient has become a person without immunity. "If the transplant cannot be made on time, it will be particularly dangerous, and the person will easily disappear."
put all one's eggs in one basket
On January 11, when Li Yunfei was lying in the collection room, medical staff asked him every half an hour: Is his face, mouth, and tongue numb?
Will the position of the needle be uncomfortable?
He said no, no.
He recalled later that the pain was not considered pain, but his arm felt swelling.
The most important thing is still unable to move, stiff and slightly uncomfortable.
Li Yunfei received a needle in each of his left and right arms.
The blood cell separator was operating next to him. There were five black valves like round buttons on the surface of the machine, each operating counterclockwise.
Pan Hongjuan explained that Li Yunfei's right hand is the blood sampling end, through which blood flows out of the body and enters the blood cell separator, where it is centrifuged to separate different components.
The hematopoietic stem cells were separately introduced into an empty bag, and the remaining components were returned to Li Yunfei's body via the left hand.
Pan Hongjuan approached the blood cell separator from time to time and observed the working status of the machine through the transparent observation point on the right side of the machine.
She believes that this collection is different from the past: stem cell collection cannot always be done at one time. Depending on the physique and state of the recipient, if the amount of a single collection is not enough, multiple collections are possible.
During the epidemic, in order to avoid Li Yunfei staying in Shijiazhuang for too long, the hospital still formed a special management team for collecting stem cells under the shortage of medical care, and analyzed Li Yunfei's physical condition, blood vessel condition and corresponding machine parameter settings, in order to complete it all at once. collection.
Pan Hongjuan said that in addition to regular disinfection, the hospital disinfected and wiped the ground and countertops of the collection room one day in advance; and irradiated it with ultraviolet light for one hour to disinfect the indoor air.
This collection also made Zhang Xinjun quite nervous.
At the beginning of November last year, Zhang Xinjun learned that there were three donors who had successfully matched Beijing patients, but one could not be contacted, and the other was unwilling to donate stem cells due to family reasons. Zhang Xinjun was a little relieved after receiving a positive reply from Li Yunfei.
On January 4 this year, Zhang Xinjun informed Li Yunfei to report to Shijiazhuang on the 6th, and feared that he would refuse. "There were cases in Shijiazhuang on the 3rd and 4th, and most people would definitely avoid coming here at this time." Yes.
On the evening of January 6, Li Yunfei and his wife arrived in Shijiazhuang.
Zhang Xinjun went to the Shijiazhuang High-speed Railway Station to wait and found that guards had been set up around the station, and people and cars were not allowed to enter.
It was the coldest day since the beginning of the new year in Shijiazhuang. The wind was blowing, the sky was white and cloudless, and there were few figures on the ground.
Zhang Xinjun stood on the road 300 meters away from the high-speed rail station for nearly an hour, and only 30 people passed by.
He was a little nervous at the time, "I want to send out the stem cells after collecting them? How to get out?"
Then he learned that Shijiazhuang was under closed-loop management.
"At first I thought it was not so strict, but later I found out that it was not such a thing. It was to completely control the personnel and vehicles going out." He tried to coordinate with the traffic control department, but verbally reported that it didn't work. "It needs the approval of the epidemic prevention and control headquarters. ...I thought about it again, even if approved, you can go on the highway. In special times, what if there is a special situation and traffic jams on the road?"
He therefore reported to his superiors.
The Provincial Red Cross has decided to entrust the Hebei Branch and the Shijiazhuang Red Cross to jointly coordinate the collection of hospitals, epidemic prevention and control headquarters, Hebei Provincial Public Security Department Traffic Management Bureau, and Municipal Traffic Management Bureau, in order to open a green channel for the delivery of stem cells.
Due to the large number of departments involved, the declared implementation plan was revised several times and was finally completed at 9pm on January 10.
After it was reported to various departments, it was quickly approved and implemented.
Zhang Xinjun commented that this move was desperate: "Although we knew that it would be approved in the end, we were still worried that it would not be approved. At that time, there were no alternatives. If it was not approved, the patient's life would be in extreme danger."
At 11 o'clock on January 11, Shijiazhuang Red Cross staff member Zhang Lei arrived at the Third Hospital of Hebei Medical University.
The collection time of stem cells varies.
The original plan was to complete the collection at two in the afternoon, and then the relevant personnel would set off from the hospital to Beijing.
After hearing that the collection would end early, Zhang Lei had a phone call with the Shijiazhuang Traffic Management Department to inform them to come half an hour earlier.
"It's cold and everyone is busy. It is definitely not good for the traffic police to waste time outside. Just think about contacting them at any time to see how they can be better connected."
At 1:40, Zhang Lei went to check outside the hospital and found that the traffic police convoy was already in place.
"Seeds of Life" set off
The collection work ended at 1:15 pm.
According to Pan Hongjuan, during the five-hour collection process, Li Yunfei's blood was continuously drawn and infused back. The total circulating blood volume was 11,182 milliliters, which was nearly 2.5 times the total blood volume of the human body.
"Hematopoietic stem cells are mainly stored in our bone marrow. The content of hematopoietic stem cells in peripheral blood (ie arterial blood and venous blood) only accounts for 1% to 10% of the bone marrow." Pan Hongjuan explained that human venous blood cannot be extracted in large quantities. .
In order to increase the content of hematopoietic stem cells in peripheral blood, Li Yunfei has been transported by Zhang Xinjun to the Provincial Third Hospital for "mobilization injections" every day since January 7.
At seven o'clock in the morning and evening, nine shots were given.
Li Yunfei described that "mobilization shots" are similar to vaccines, both of which are sticking to the upper arm.
The "mobilization needle" is prone to adverse reactions after injection. His backache, dizziness, and calf pain are "the same as after a long-distance race."
In the end, the blood cell separator collected 357 ml of hematopoietic stem cell suspension from Li Yunfei.
After removing the collection bag, Pan Hongjuan briefly shakes to mix the liquid.
This bag is like a "seed of life" stem cell suspension, showing a pale pink color.
At about 1:30, Li Yunfei sat up from the bed with his hands wrapped in tape, moving slowly.
He recalled that after lying down for too long, he got up lightly.
His wife stepped forward to support him.
Aside, Zhang Xinjun put on his headgear, mask, and protective clothing, and took a dark blue incubator for stem cell transportation.
The outside of the box is made of nylon, and the inside is insulated.
He sprayed and killed the inside and outside of the box with 75% alcohol, and then put a temperature-controlled ice tray inside the box.
Then he took out two pieces of cloth, one yellow and one white, and killed them separately; he took the stem cell suspension collection bag, spread out the two pieces of cloth, wrapped one layer, cushioned one layer, and put them into the transport box together.
After closing the box, disinfect the outside again.
At 1:50, Zhang Xinjun bid farewell to Li Yunfei and others and took the ambulance in the hospital.
At 2 o'clock, the ambulance started and set off.
Starting from the south gate of the Provincial Third People's Hospital, Shijiazhuang Traffic Management Department sent a police car to clear the road and two motorcycles to escort the road.
The convoy turned into Normal Street, entered Yuhua Road, and went straight to the Yuhua Road Intersection.
Zhang Xinjun sat in the center of the ambulance, resting the incubator for stem cell transport on his knees, supporting each other with his hands.
He looked out, and there were two traffic policemen directing at each intersection, "I can't see clearly inside, but I feel like I haven't stopped at one intersection, and the cars on both sides have been commanded to give way."
There are more than ten kilometers from the Provincial Third Hospital to the Yuhua Road Highway.
It took about half an hour to drive, but it took less than 15 minutes that day.
About a quarter past two, Zhang Xinjun got out of the car, and the wheat-colored sun was heading right in the winter.
An ambulance from Beijing has been waiting here.
Zhang Xinjun met with the Beijing staff, took out the form, and checked the donor and his stem cell donation information.
Then sign the incubator for stem cell transportation.
Time is not waiting, the Beijing ambulance was launched immediately, guided by a police car from the Shijiazhuang Detachment of Hebei Expressway Traffic Police, sounded a few horns and drove onto the Xinyuan Expressway section.
More than 110 coordination and organization calls were made in one day
At 8 o'clock in the morning on January 11, the staff of Hebei Provincial Traffic Management Bureau Yu Shiqiang began to call traffic management departments at all levels and across the province to deploy personnel to carry out escort tasks in the afternoon.
The night before, he received a call from Zhang Lei, requesting the Hebei Provincial Traffic Police to escort the hematopoietic stem cell suspension donated by Li Yunfei to the border of Hebei Province and hand it over to Beijing.
The Hebei Provincial Traffic Management Bureau issued a preliminary notice overnight-Shijiazhuang City Traffic Management Bureau is responsible for traffic security; Hebei Provincial Highway Section is in charge of the Provincial Public Security Department Highway Traffic Police Corps, which is further subdivided into Shijiazhuang Section and Baoding Section.
Yu Shiqiang introduced that on January 11, 25 posts and more than 50 police officers were deployed in Shijiazhuang City; there were 110 police officers and 32 police vehicles on the highway section.
The whole journey was more than two hundred kilometers. From morning to night, he made more than 110 coordination and organization calls.
Wang Dongwei, head of the Legal Affairs Section of the Baoding Detachment, is the police escort for the Baoding section of the highway, responsible for the 170-kilometer section from the Dingzhou service area to the border of Hebei Province.
At 1 pm, he set off from Baoding Detachment and arrived at the Dingzhou service area of Beijing-Hong Kong-Macao Expressway before two o'clock. He stopped at the roadside outside the service area, waiting for departure at any time.
At about 3:10, Wang Dong did not see the Shijiazhuang Detachment's vehicles approaching behind him, so he started the car to accelerate forward and raced against the clock to replace the Shijiazhuang Detachment police car to ensure that the ambulance behind him did not have to slow down.
In the command center of the high-speed traffic police corps, Secret Service Captain Shi Qiusheng is responsible for supervising the whole process.
He explained that the command center has a set of monitoring and positioning system, which is operated by dispatched personnel from the Highway Administration Bureau, which can track the ambulance fleet in real time with almost no blind spots.
On the high-speed section of Baoding's jurisdiction, Wang Dong kept in touch with the command center without using a handheld radio to report the speed and location.
Ten police patrol cars from the three brigades of Dingzhou, Baoding, and Zhuozhou also need to be in touch at any time to ensure the smoothness of the road. “If you encounter a traffic accident, you must clear it quickly to ensure that the fleet passes at the original speed.”
According to Wang Dongwei’s experience, the traffic flow between the Beijing-Hong Kong-Macao Cangyu Interchange and Rong-Wu Interchange is too heavy, so he took precautions and arranged three police patrol cars within a drive of less than 30 kilometers.
In fact, the traffic flow along the way was generally scarce that day, and private car owners took the initiative to avoid ambulances and police cars.
The Beijing-Hong Kong-Macao Expressway presents the openness unique to the north.
The sun gradually sets west, and the sky looks like water stained with rice paper, spreading out grayish white.
At 4:24 pm, the command center called Wang Dongwei via radio.
"Interact with the Beijing police in advance..."
"Understand, understand, the Beijing police have already connected..."
"Okay, close communication, seamless connection."
Maintaining a speed of about 110 kilometers per hour all the way, Wang Dongwei's motorcade arrived at the border of Hebei province at 4:40.
The Beijing police car that had been waiting here flashed its lights to indicate that Wang Dong and his colleagues left the convoy before returning to Baoding.
The Beijing police car continued to lead the car in, and there were also police arrangements along the way.
"No matter what the situation is, it will be donated"
At 5:30 in the afternoon, dusk is approaching.
Under the escort of Beijing traffic police, the incubator for stem cell transportation arrived at a hospital in Beijing.
The ambulance was suspended in the hospital, the transport box was killed several times, and the docking documents were also stored in the isolation bag.
The patient’s attending physician wears gloves and takes out the stem cell suspension bag. After the inventory is completed, he takes it to the stratospheric ward upstairs.
According to Zhang Xinjun, 357ml of stem cell suspension was infused into the patient's body that night.
The patient’s condition is relatively stable, and he needs to stay in a sterile stratospheric ward for about 20 days to observe and deal with rejection reactions after transplantation.
At the other end, after a short break in the Third Provincial Hospital, Li Yunfei and his wife underwent a nucleic acid test and were sent back to their hotel by Zhang Xinjun.
On January 11th, Li Yunfei ordered a potato stew for dinner. He finally tasted the smell of meat for a long time.
Zhang Xinjun praised Li Yunfei as a "retrograde man".
Zhang Xinjun remembered that on the afternoon of January 6, he was connected to Li Yunfei and his wife at Shijiazhuang High-speed Railway Station, and the three of them walked to the parking spot together.
He couldn't help but thanked Li Yunfei, "but he said back to me that he had thought about it when he joined the China Bone Marrow Bank. No matter what the situation is, he must donate."
At noon the next day, Zhang Xinjun and his colleagues picked up Li Yunfei and his wife, went to the Traffic Management Bureau to collect the passage materials, and arranged for a vehicle to take the two to the Guantao County high-speed toll station, which was taken over by the local Red Cross.
The two are still in isolation at home, and their relatives deliver vegetables to their door every day.
The two only watched TV, surfed the Internet and played flowers and plants at home.
Li Yunfei said that he still feels a little bit weak, or it will take some time to fully recover.
He has not smoked for nearly a month.
This is not the first time he has quit smoking. He has quit several times before, but the longest is only a week.
Today, the addiction is still committed, but he is determined to persist, "Use this opportunity to see if we can quit it completely."
(In order to comply with the principle of “double blindness” between donors and patients in hematopoietic stem cell donation, Li Yunfei is a pseudonym in the text)
Beijing News reporter Feng Yuxin