Миелоэксфузия

4 Иглы
4 шприца на 22 мл

Обычные гемоконы

Важный коннектор

Обработка операционного
поля

Операционное поле
Обложено стерильным бельем

Ромб Михаэлиса

Где пунктируют

Работает 4 человека

и анестезиологи

РАСЧЕТЫ (гепарин)
Общий объем костного мозга 15-18-20 мл/кг массы тела реципиента;
Рабочий раствор: Гепарин 25 000 Ед на 500 мл физ. р-ра (концентрация 50 ед/мл)
В шприц набирают 4 мл рабочего раствора (=200 ед. гепарина);
Конечная концентрация гепарина 10 ед на 1 мл костного мозга ;
На одну процедуру уходит 2-3 флакона рабочего раствора.

Количество мешков
m реципиента 70 кг
V костного мозга = 18х70=1260 мл
Общий объем с учетом добавления рефортана = 1575 мл (соотношение рефортан: костный мозг = 1:4)
1575 мл = 3,5 гемакона по 450 мл = 4 гемакона

Количество пункций
В один гемакон на 450 мл набирают 330 мл костно-мозговой взвеси = 15 шприцов по 22 мл (4 мл рабочего раствора + 18 мл костного мозга)
15
15
15
15
ИТОГО 60 пункций

Из 4-х проколов кожи с каждой стороны (итого 8 проколов)
Из одного прокола кости максимум набирают 2 раза на разной глубине;
После каждого прокола кости меняют иглу
Как пунктируют

Cobifix adapter
Record ->Luer

Миелоэксфузия завершена

Миелоэксфузия: модификация
Астана, 30.12.2015

Предпосылки

Representative images of CXCL12+ cells in bone marrow samples. Scale bar indicates 25 μm. (a–d) CXCL12+ cells in control bone marrow. Arrowheads indicate CXCL12+ cells (brown). CXCL12+ cells are located among hematopoietic cells (a), around adipocytes (b), and in the perivascular area together with capillaries (c) or sinusoids (d). Asterisk indicates the lumen of the sinusoid. (e–g) CXCL12+ cells in myelodysplastic syndrome (MDS) (e), acute myelogenous leukemia with myelodysplasia-related changes (AML-MRC) (f), and AML, not otherwise specified (AML-NOS) (g) bone marrows. Note that CXCL12+ cells increased in MDS and AML-MRC bone marrow, but were scarce in AML-NOS bone marrow.

TRADITIONAL NEEDLES produce excess peripheral blood contamination, diminishing cellular yield; thereby requiring additional manipulation steps to achieve the cellular demand necessary for most clinical indications.
MARROW CELLUTION™ uses its patent pending technology to harvest high quality stem and progenitor cells from various levels within the marrow space, while limiting peripheral blood contamination.

Bone Marrow Transplant. 1992 Jun;9(6):467-70.
Bone marrow harvest for marrow transplantation: effect of multiple small (2 ml) or large (20 ml) aspirates.
Bacigalupo A1, Tong J, Podesta M, Piaggio G, Figari O, Colombo P, Sogno G, Tedone E, Moro F, Van Lint MT, et al.
Author information
Abstract
The aim of this study was to evaluate the yield of nucleated cells and CFU-GM and the T cell composition in bone marrow harvested by means of multiple small (2 ml) or large (20 ml) aspirations. Eleven marrow donors were studied: each donated 1000 ml of bone marrow in two aliquots of 500 ml for an HLA identical sibling transplant. In six cases the first 500 ml were harvested by means of multiple 2 ml aspirations (A) and the second 500 ml by means of 20 ml aspirations (B). In five cases the opposite was done: 20 ml aspirates first (C) and 2 ml afterwards (D). From each 500 ml aliquot a sample was taken for enumeration of nucleated cells and CD3+ lymphocytes and for CFU-GM growth. Small volume aspirations (groups A and D) yielded more nucleated cells (p = 0.02), more CFU-GM (p = 0.03) and fewer CD3+ cells (p = 0.1) when compared with large volume aspirations (groups B and C). This study shows that marrow harvesting by means of multiple small volume aspirations minimizes the dilution with peripheral blood and results in greater numbers of cells and hemopoietic progenitors.