#neutropenia

[chronicallymistreated]

My name is Cherry and I am a black woman in my late twenties struggling with a load of physical disabilities. I am a part-time wheelchair user and use walking aids daily.

I'm looking to make friends in the community. I'm also autistic and struggle with CPTSD which really sucks.

More about me under the cut...

I'm currently diagnosed with:

Fibromyalgia

CFS/ME

Chronic Migraines (With Aura)

Chronic Neutropenia

Polycystic Ovary Syndrome (PCOS)

Radiculopathy

Sciatica

Endometriosis

I'm currently being assessed for:

Ehlers-Danlos Syndrome

PMDD

Postural Orthostatic Tachycardia Syndrome (POTS)

If you spread any kind of hate you'll be blocked. I shouldn't have to spell this out either...

[medicomunicare]

Avapritinib: la nuova opportunità per trattare i tumori cerebrali pediatrici?

I ricercatori dell’Università del Michigan, del Dana Farber Cancer Institute e della Medical University of Vienna hanno creato un team collaborativo per scoprire una potenziale nuova strada per affrontare il glioma di alto grado. Il loro studio, pubblicato su Cancer Cell, mostra che le cellule tumorali del glioma di alto grado che ospitano alterazioni del DNA nel gene PDGFRA hanno risposto al…

[unibytekids]

Introducing the premium quality Podkiv-25 Drops from Unibyte Kids

It treats various infections

For More Info:

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[loreandtempo]

Neutropenia Genetic Test Results 🧬

It’s just after midday, I’m finishing up with a member at work, and my Apple Watch pops up with a call. It’s from Melbourne. Who do I know that would be calling me from there right now? In my mind, it could only one person. The genetic councillor from VCGS who had my little girl’s genes looked at. My heart jumps up into my throat, and I answer the call out back. After weeks of waiting and…

[jhjgjhyfthdrtd]

https://www.einpresswire.com/article/727659772/the-rising-demand-in-the-global-neutropenia-treatment-market

[literaryvein-reblogs]

Some Allergy Vocabulary

for your next poem/story

Allergic crease - A crease or pale line that develops across the lower part of the nose because of frequent upward wiping of the nose.

Angioedema - (or edema) Swelling

Dander - Material that is shed from the body of humans and animals that have fur, hair, or feathers.

Dust mite - A small mite invisible to the naked eye. Dust mites are widely distributed in homes and dust mite allergy is a major cause of asthma and allergic rhinitis (hay fever).

Elemental diet - A diet of predigested liquid containing amino acids, vitamins, minerals, electrolytes, and glucose.

Eosinophils - Cells that circulate in the blood. They attack tissues at the site of an allergic reaction causing damage.

Erythema - Reddening of the skin.

Macrophages - Scavengers whose job is to engulf or eat up infecting germs and even infected cells. Macrophages also help to overcome infection by secreting signals that help activate other cell types to fight against infections.

Monocytes - Cells that circulate in the blood and become macrophages in the tissues. These cells are very important in alerting the immune system about an infection.

Neutropenia - A condition that results when the body does not have enough neutrophils, an important white blood cell that fights infections. The lower your neutrophil count, the more vulnerable you are to infectious diseases.

Pollen count - (or a mold count) Is based on the measurement of the number of grains of pollen or mold spores in a cubic meter of the air. The higher the count, the greater the chance that people suffering from hay fever will experience symptoms when they are outdoors or exposed to outdoor air.

Pruritus - Itching

Urticaria - The medical word for hives, which are itchy, raised lumps that can vary in position from hour to hour or day to day.

Wheal - A raised whitish itchy lump, which occurs after skin prick test or after contact with an allergen and is a term also used to describe the individual lump seen in hives.

Wheeze - A whistling sound that can occur in the breathing tubes or airways. It is important to make your doctor aware of wheezing that reoccurs. Wheezing is often a symptom of asthma or COPD, but it may be related to temporary respiratory conditions such as pneumonia or bronchitis.

Sources: 1 2 3 ⚜ More: Word Lists

[doctorbitchcrxft]

Something Wicked | Supernatural Series Rewrite | Dean Winchester x Reader

Pairing: Dean Winchester x Reader

Warnings: canon violence, canon gore, implications of verbal parental abuse

Word Count: 4885

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The two boys were bickering over coordinates Dean had received from an anonymous number. 

“Dude, I ran LexisNexis, local police reports, newspapers, I couldn't find a single red flag. Are you sure you got the coordinates right?” Sam asked.

“Yeah, I double checked. It's Fitchburg, Wisconsin. Dad wouldn't have sent us coordinates if it wasn't important, Sammy.”

“Well, I'm telling you, I looked, and all I could find was a big steamy pile of nothing. If Dad's sending us hunting for something, I don't know what.”

“Well, maybe he's going to meet us there.”

“Yeah. ‘Cause he's been so easy to find up to this point.”

You sighed. You weren’t about to get in the middle of this argument and tuned the rest of it out. Alas, Dean won the argument, as he often did. 

You stopped for some coffee along Fitchburg’s main street. The town itself was small, but it was quaint. A little too Middle America for your taste.

“Well… the waitress thinks the local freemasons are up to something sneaky, but other than that, no one's heard about anything freaky going on,” Dean sighed, handing you and Sam your respective coffee orders.

“Dean, you got the time?” you asked him.

“Ten after four. Why?”

You nodded in front of you at the playground you were looking at. “What's wrong with this picture?”

It was deserted aside from one child climbing on the jungle gym.

“School's out, isn't it?” Dean questioned.

“Yeah. So where is everybody?” Sam added. “This place should be crawling with kids right now.”

You and the Winchesters walked over to a woman on a park bench reading a magazine. Dean approached her, saying, “Sure is quiet out here.”

The woman sighed, “Yeah, it’s a shame.”

“Why's that?”

“You know, kids getting sick, it's a terrible thing.”

“How many?”

“Just five or six but serious, hospital serious. A lot of parents are getting pretty anxious. They think it's catching,” she explained.

All four of you watched the little girl playing by herself, and the wheels in your head began to turn. Why would John send you all the way to Fitchburg over a few sick kids?

The three of you made your way up to the pediatrics ward of the hospital to investigate the sick children. Dean and Sam donned suits, and you wore a pencil skirt and heels. You couldn’t lie to yourself, Dean looked amazing in his suit, but you much preferred his usual leather jacket and biker boots. 

“See something you like?” Dean smirked at you.

Your mouth opened and closed, unsure of what to say. He just snickered in response while your cheeks burned.

A doctor approached you and the boys before Dean could taunt you any further. You introduced yourselves and headed down the corridor with the man. “Well, thanks for seeing us, Dr. Hydecker,” Dean said.

“Well, I'm glad you guys are here. I was just about to call CDC myself. How'd you find out anyways?” the doctor asked.

“Oh, some GP— I forget his name— he called Atlanta, and, uh, he must've beat you to the punch,” Dean lied.

“So you say you got six cases so far?” you asked.

“Yeah, five weeks. At first we thought it was garden variety bacterial pneumonia. Not that newsworthy. But now…”

“What?”

“The kids aren't responding to antibiotics. Their white cell counts keep going down. Their immune systems just aren't doing their job. It's like their bodies are... wearing out.”

“Wait, but are there any signs of leukopenia?” you asked. “Any history in these kids of that?”

Dean looked over at you, confused by what you were saying. You continued to talk to the doctor.

“No, actually,” Hydecker answered. 

“What about neutropenia?”

He shook his head as a nurse handed him a clipboard full of papers.

“Then, whatever this is would have to be attacking the bone marrow as well as the respiratory system… Have you done biopsies?”

“No, we haven’t,” Hydecker answered. “I’ll give that a try.”

“You ever seen anything like this before?” Sam questioned.

“Never this severe,” the doctor said. “And the way it spreads… that's a new one for me.”

“What do you mean?” asked Sam.

“It works its way through families. But only the children, one sibling after another.”

“You mind if we interview a few of the kids?” Dean questioned.

“They’re not conscious,” the doctor replied.

You were shocked. “None of them?”

“No.”

“Can we, uh, can we talk to the parents?” tried Dean.

“Well, if you think it'll help.”

“Yeah. Who was your most recent admission?”

Hydecker directed you to a man sitting on a chair against the wall in the waiting room. He looked like he hadn’t slept in days. He explained to you the oldest girl was first, and then his youngest. He told you that her window had been opened, but there was no one who could’ve done so except for his daughter because her room was on the second floor. 

You and the boys headed out of the pediatrics ward and back toward the car. 

“(Y/N), how’d you know all that stuff?” Sam asked you, referencing your conversation with the doctor.

“I like to read,” you shrugged. Sam smiled at your response and walked a little ahead of you. 

Dean came up next to you. “You were really serious about nursing, huh,” he said softly enough so Sam wouldn’t hear.

“I guess. I really do just like to read, though,” you smiled. “I think I just wanted to stick it to my dad. I always thought I’d be happier not hunting. But, uh, I just don’t think I could ever go back to being ‘normal’.”

“Yeah, I get that,” he responded. 

Sam turned back to you and his brother. “You know, this might not be anything supernatural. It might just be pneumonia.”

“No way,” you shook your head, “pneumonia wouldn’t be lowering white blood cell count. It’d have to be elevated for it to be true pneumonia. Infection and all that.”

Sam hummed. “Okay, so then what’s your theory?”

“Honestly? Not sure.”

“I'll tell you one thing,” said Sam. “That dad we just talked to? I'm betting it'll be a while before he goes home.”

***

“You got anything over there?” Sam asked Dean. The three of you had climbed through the home of the last two kids who had gotten sick looking for clues.

“Nah, nothing,” the older brother answered.

“Yeah, me neither,” you chimed in. You moved over to the window and paused. “Hey guys? I really don’t think it’s pneumonia.”

The boys came over and followed your line of sight to a rotted handprint with long, tendril-like fingers. 

“What the hell leaves a handprint like that?” Sam asked.

Dean seemed to get pulled away into his own mind for a moment before he began to look a little sick. “I know why Dad sent us here. He's faced this thing before. He wants us to finish the job.”

Dean raced down the stairs to the window on the back of the house you’d climbed through. You followed him close behind. You would ask him what had happened to him in the little girl’s bedroom later.

Dean explained to you on the ride to the motel what he thought you were hunting: a shtriga.

“So what the hell is a shtriga?” Sam asked as Dean pulled into a motel parking lot. This motel was a little cuter than the ones you’d visited previously; centered around a white cabin with green shingles. 

“It's kinda like a witch, I think. I don't know much about 'em,” explained Dean.

“Well, I've never heard of it. And it's not in Dad's journal.”

“Dad hunted one in Fort Douglas, Wisconsin, about sixteen, seventeen years ago. You were there. You don't remember?”

Sam shook his head.

“And I guess he caught wind of the things in Fitchburg now and kicked us the coordinates,” Dean went on.

“So wait, this…” Sam paused, waiting for Dean to remind him how to pronounce it.

“Shtriga.”

“Right. You think it's the same one Dad hunted before?”

“Yeah, maybe.”

“But if Dad went after it, why is it still breathing air?” Sam’s brows furrowed together.

“ ‘Cause it got away.”

Sam scoffed. “Got away?”

Dean was beginning to get frustrated, and you knew it was a cover-up for whatever was going on inside his head. “Yeah, Sammy, it happens.”

“Not very often.”

“Well, I don't know what to tell ya, maybe Dad didn't have his wheaties that morning,” snarked the older brother.

“What else do you remember?”

“Nothin'. I was a kid, alright?” Dean said defensively. You followed him into the motel lobby only to see a little boy watching TV in one room and a boy around ten or eleven walking out of it.

“A king or two queens?” The boy asked, looking between you and Dean.

“Two queens,” you and Dean answered quickly. “And one king, actually,” you added, stepping aside to reveal Sam behind you.

A woman entered smiling at you both. “Checking in?”

You nodded to her.

“Do me a favor, go get your brother some dinner,” the woman instructed the boy. 

“I'm helping a guest!” he protested, but turned away under his mother’s hard stare. “Two queens. And a king.”

“Will that be cash or credit?” she asked you.

Dean took out his card. “You take MasterCard? Perfect. Here you go.”

You watched him look behind the woman at the boy pouring his younger brother a glass of milk. And there he went again; pulled into what you could only assume was memories of himself and Sam.

The woman before you held out his card to zoned-out Dean, and you took it from her instead. “Uh, thanks.” She handed you the keys, and you nudged Dean to bring him back to reality.

***

Dean explained to you and Sam what shtrigas fed off: children, most commonly. The only thing that could kill them were specially designed wrought-iron rounds while the thing was feeding. They often take the form of something unsuspecting; like an old woman.

“Hang on,” Dean said. “Check this out. I marked down all the addresses of the victims. Now these are the houses that have been hit so far and dead center?”

“The hospital,” you noted.

“Now, when we were there, I saw a patient; an old woman,” Dean continued.

“An old person huh?” questioned Sam. “In a hospital? Phew. Better call the Coast Guard.”

You giggled at Sam.

“Well, listen, smart-asses, she had an inverted cross hanging on her wall.”

You and Sam stopped snickering and looked up at Dean. He raised an eyebrow at you.

And so, you headed to the hospital. Fortunately for her— but unfortunately for your hunt— the old woman with the upside down cross on the wall was just cataract-ridden and crotchety. Upon your return to the motel after thoroughly freaking out the old woman, you pulled Dean to your motel room for a talk before bed.

“What’s up?” he asked, sitting on a chair in your room. 

You sat on the bed across from him. “Where do you keep going?” you asked.

“Huh?”

“Sorry, I just realized how stupid that sounded. You keep, like, disappearing into your own brain,” you responded. “Like in the motel lobby. You zoned out looking at that kid and his brother.”

“Oh, that,” he said quietly. “I, uh, it’s stupid.”

“Dean,” you leaned over your crossed legs and rested your hand on his knee. “I’m asking you. It’s not stupid. I just care.”

“Oh, come on—”

“Dean,” you said. “You made me a pinky promise at that scary asylum. You promised you’d tell me. Please?”

He huffed out a small laugh. “You know how I said my dad hunted this thing before?”

You nodded.

“Well, I’m the reason it got away.”

“How? Didn’t you say it was sixteen, seventeen years ago? You would’ve been ten, dude,” you responded.

“Yeah, but it’s complicated. My dad left us alone in motel rooms all the time. He made me repeat to him what I was and wasn’t supposed to do every time he would go out on a hunt. Sam and I would fight over the last bowl of Lucky Charms from the groceries Dad got us for the week; y'know, stupid kid stuff,” he chuckled. “But it’d been days. I was climbin’ the walls, (Y/N). I had to get some air. I went to an arcade to just… blow off some steam, I guess.

"When I came back, the thing was over Sammy’s bed. I was frozen. My dad came in and shot it a couple times, but it got away. Dad just... grabbed us and booked. Dropped us off at Pastor Jim's about three hours away, but by the time he got back to Fort Douglas, the shtriga had disappeared; it was just gone. It never surfaced until now. Y'know, Dad never spoke about it again, I didn't ask." He looked away from you attempting to swallow his emotions. "But he, ah, he looked at me different, you know? Which was worse. Not that I blame him. He gave me an order, and I didn't listen; I almost got Sammy killed.”

“Dee, you were a kid,” you said softly. He went to cut you off, but you stopped him. “No, let me talk. I know how that feels. My parents left me with Stevie all the time. I would've done the same thing you did. We were kids. We had to take on parental responsibilities. Anybody would be going stir crazy, especially at ten years old like you were.”

“(Y/N)—”

“No,” you told him, grabbing his hand. “You cannot blame yourself. I won’t let you. Would you let me?”

He shook his head.

“Exactly.”

He held your intense stare and rubbed a thumb over your hand. The two of you awkwardly pulled away from each other, and Dean cleared his throat. “Uh, thank you, for, y’know—”

“Yeah, any time,” you said, walking him to the door. 

***

The next morning, you and Sam were teasing Dean about the old woman from the hospital the night before. You were headed to the car to go get some breakfast.

“ ‘I was sleeping with my peepers open’?” Sam laughed heartily, remembering the old woman's strange way of talking.

“I almost smoked that old girl, I swear. It's not funny!” Dean grunted.

“Oh man, you shoulda seen your face,” you giggled.

“Yeah, laugh it up. Now we're back to square one.” He looked over to the ten-year-old blond boy sitting on the bench behind his mother’s office. “Hang on.” He led you over to the child. “Hey, what's wrong?”

“My brother's sick,” he replied.

“The little guy?”

He nodded. “Pneumonia. He's in the hospital. It's my fault.”

“Ah, c'mon, how?” You could tell Dean’s mind was racing just based on his tone.

“I should’ve made sure the window was latched. He wouldn't've got pneumonia if the window was latched,” the boy lamented.

You watched, frowningly thoughtfully, as Dean looked away from the boy. 

“Listen to me. I can promise you that this is not your fault. Okay?” Dean assured him.

“It's my job to look after him,” the boy frowned, tearing up.

His mother hurried out of the motel toward her minivan. “Michael, I want you to turn on the 'no vacancy' sign while I'm gone. I've got Denise covering room service, so don't bother with any of the rooms.”

“I'm going with you,” he protested.

“Not now, Michael.”

“But I gotta see Asher!”

Dean responded before his mother could. “Hey, Michael. Hey. I know how you feel— I'm a big brother, too— but you gotta go easy on your mom right now, ok?”

His mom dropped her handbag in haste, cursing under her breath. You rushed to pick it up for her.

“Listen, you're in no condition to drive. Why don't you let me give you a lift to the hospital,” Dean offered.

“No, I couldn't possibly—” she answered.

“No, it's no trouble. I insist.”

Michael’s mother handed Dean the keys and thanked him before addressing her son. “Be good.”

Dean turned to you before he went over to the car. “We're gonna kill this thing. I want it dead, you hear me?”

You and Sam watched Dean pull out of the motel parking lot, driving much more carefully than he ever did when you and Sam were in the car.

“C’mon,” you said. “You got the keys?”

“Yeah,” he threw them to you. “Where we goin’?”

“Wait, you’re letting me drive?” you asked Sam.

He shrugged. 

You squealed childishly and jumped into the driver’s seat. You couldn’t lie, you loved this car. You loved how the steering wheel felt in your hands and the way the engine rumbled. 

“Seriously, where we going?”

“The library,” you answered. “Town records, national records, internet, anything and everything. Dean wants this thing dead, and I intend to get it done tonight. And I gotta tell you, dude, something’s really bothering me about this whole thing. I mean, I never even formally went to nursing school, but I knew it couldn’t be pneumonia immediately. Why would pediatric doctors be unable to figure that out?”

He shrugged. “I don’t know, but I get you. Something isn’t right.”

***

You and Sam poured through as many books you possibly could as quickly as you could. Sam was at his computer, scrolling with a furrowed brow when his phone rang. “ Hey. How's the kid?... We’re at the library. We've been trying to find out as much as we can about this shtriga… Well, bad news. I started with Fort Douglas around the time you said Dad was there?... Same deal.

"Before that, there was, uh, Ogdenville, before that, North Haverbrook, and Brockway. Every 15 to 20 years, it hits a new town. Dean, this thing is just getting started in Fitzburgh. In all these other places, it goes on for months. Dozens of kids before the shtriga finally moves on. The kids just languish in comas, and then they die… Ah, I don't know. The earliest mention I could find is this  place called ‘Black River Falls’ back in the 1890s. Talk about a horror show.”

Your brain began to make connections between all of those events. “Wait, Sam, put Dean on speaker.” 

He did so.

“Okay, you’re gonna have to stay with me on this one. This could just be me spitballin’, but—”

“Just say it, (Y/N),” Dean said through the phone.

“I’ve been thinking, why wouldn’t Hydecker immediately rule out pneumonia? If he’s such a spectacular and caring doctor, why wouldn’t he know that pneumonia ups your white blood cell count; not depletes it? And the chance of all six kids having a pre-existing condition that lowers your WBC is incredibly low. I mean, why else wouldn’t he biopsy the kids?”

“Okay, WebMD, what does that have to do with anything?” Dean asked.

“I told you to stay with me.” You began typing in your computer searching for articles on the earliest case Sam had found in Black River Falls. “The point is, I think Hydecker’s our guy. Think about it— the center of the kidnappings is the hospital. And any pediatric doctor would be familiar with what pneumonia actually does to a kid’s body.” You smiled sourly at a photo you pulled up of doctors surrounding a child’s bed in 1893. You turned the computer around to Sam. “Boom.”

“(Y/N), that is huge.” He leaned over and lightly punched your shoulder. “Good going.”

“Thanks!” you grinned. “Dean, meet us back at the motel. Don’t deck the guy in the face, please. Not yet, anyway.”

“No promises,” he grumbled.

“Dean—”

“Fine.” He hung up the phone.

“Alright, we gotta get back before Dean explodes,” you told Sam. “Can I drive again?”

“Sure, why not. Just don’t tell my brother.” He tossed you the keys and you giggled.

***

“We should have thought of this before. A doctor's a perfect disguise. You're trusted, you can control the whole thing,” Sam said. 

You and the brothers were back in the motel room. 

Dean threw off his jacket and paced agitatedly. “That son of a bitch.”

“I'm proud of you for not drawing on him right there,” you said.

“Yeah, well, first of all, I'm not going to open fire in a freakin' pediatrics ward.”

Sam nodded. “Good call.”

“Second, wouldn't have done any good, because the bastard's bullet proof unless he's chowing down on something. And third, I wasn't packing, which is probably a really good thing, ‘cause I probably would've just burned a clip in him on principle alone.”

Despite the situation, you found Dean aggressively grumbling about guns very attractive.

“You're getting wise in your old age, Dean,” Sam quipped.

“Damn right. 'Cause now I know how we're going to get it,” replied Dean.

“What do you mean?” you asked.

“Shtriga works through siblings, right?”

You knew what he was getting at. “No, Dean, I don’t like that.”

“What?” Sam asked, clearly not picking up where you and Dean were at.

“(Y/N)—”

“No, dude, we gotta get Michael out of here. I’m not letting you use him as bait.”

“Dean, what?! That’s out of the question!” Sam protested.

“It's not out of the question, Sam, it's the only way. If this thing disappears it could be years before we get another chance.”

“Michael's a kid. And I'm not going to dangle him in front of that thing like a worm on a hook,” Sam scoffed. 

“Dad did not send me here to walk away.” Dean turned away from you and Sam and gripped the edges of the dresser.

“Send you here? He didn't send you here; he sent us here,” Sam replied.

“This isn't about you, Sam. I'm the one who screwed up, all right. It's my fault. There's no telling how many kids have gotten hurt because of me.”

“What are you saying, Dean? How is it your fault?” Sam paused, taking a moment to calm down. “Dean. You've been hiding something from the get-go. Since when does Dad bail on a hunt? Since when does he let something get away? Now talk to me, man. Tell me what's going on.”

Dean proceeded to explain what he had to you last night. Sam gave him the same lecture about how it wasn’t his fault, but Dean began to protest again. “Don't. Don't. Dad knew this was unfinished business for me. He sent me here to finish it.”

You were surprised at the tough facade he gave his brother in contrast to the way he was vulnerable with you.

“But using Michael— I don't know Dean. I mean, how 'bout one of us hides under the covers, you know, we'll be the bait,” Sam tried.

“No, it won't work. It's gotta get close enough to feed— it'll see us. Believe me, I don't like it, but it's gotta be the kid.”

***

Michael was completely against the idea and even threatened to call the cops on you. You and the boys returned to their motel room dejectedly.

“Well, that went crappy. Now what?” Dean groaned.

“What did you expect? You can't ask an adult to do something like that, much less a kid,” the younger brother sighed.

There was a knock at the door, and you opened it to reveal Michael.

“Hey,” you said, surprised.

“If you kill it, will Asher get better?”

“Honestly? We don't know,” Dean told him.

“You said you were a big brother,” Michael started, “You'd take care of your little brother? You'd do anything for him?”

“Yeah, I would,” Dean replied quietly. Your heart swelled at how much Dean and Sam cared for each other.

The young boy nodded. “Me, too. I'll help.”

Dean had hooked up a security camera to the boy’s room, and you and he watched the monitor closely. You were beginning to feel cross-eyed from how tired you were. It was around three in the morning, and your body protested against your will to stay awake.

“You sure these iron rounds are gonna work?” Sam asked his brother.

“Consecrated iron rounds, and yeah, it's what Dad used last time.”

“Hey, Dean? I’m sorry,” the younger brother said softly. “You know, I've really given you a lot of crap, for always following Dad's orders. But I know why you do it.”

“Oh, god, kill me now,” Dean groaned.

You giggled to yourself, eyes returning to the screen. “Dean, look.”

There was a bit of movement off to the right of the screen outside of the window. You and the boys picked up your guns, holding them tightly and waiting for the right moment. 

“Now?” you asked.

“Not yet.”

The shtriga moved closer and leaned over the bed. You could see Michael tense under the covers and draw them closer to himself. The creature leaned over the bed, pushing the covers down. 

“Now?!”

“Now.”

You and the boys burst through the door and began to shoot the creature after Michael rolled away. It flew off Michael’s bed and fell to the side you couldn’t see.

“Mike, you alright?” Dean asked the kid.

“Yeah,” came his muffled reply from under the bed.

“Just sit tight.” Dean approached the shtriga, his gun at the ready. There was no movement for just a moment, before the shtriga shot up and grabbed Dean by his throat, throwing him across the room.

“Dean!” you cried, trying to run to him. The shtriga threw you to the side against Michael’s bed. Your back protested as you tried to roll and grab your gun that had fallen out of your hand in the chaos. You noticed the shtriga leaning over the top of the younger Winchester. Sam’s body went limp and began to go gray as the shtriga began to suck out his life force.

“Hey!” Dean gruffly spat. The shtriga turned to the older brother just to get shot straight between the eyes.

“Nice!” you said. You rushed to Sam’s side and smoothed a hand over his messy hair while he tried to catch his breath. “Are you okay?”

He nodded. “Thanks.”

“You okay, little brother?” Dean called from behind you. You thought it was adorable how much he cared.

You and Sam stood and you tried to help hold the tall man up on his unsteady legs. You guided him over to the shtriga, and Dean shot it three times at point-blank range. The shtriga’s body fell in on itself, disintegrating.

You looked up at Dean, whose face was still set in hard lines.

“It's okay, Michael, you can come on out,” Dean told the boy peeking out from under his bed. He rose to stand beside you, smiling tentatively. Dean put a hand on the boy’s shoulder and gave it a squeeze. You looked on, feeling your heart swell at what you knew was a full-circle moment for Dean. You knew these moments were few and far-between in a profession like yours, and you had learned to savor them in your memory.

***

You and the brothers returned to your rooms to pack now that the monster was dead. As usual, you were finished packing before the boys were and leaned against the Impala waiting for them.

You watched Michael’s mom’s car pull up in the motel parking lot. At that moment, the boys came out to join you.

“Hey, Joanna. How's Asher doing?” Dean asked the mother of the two boys.

“Have you seen Michael?” she asked him.

“Mom! Mom!” the child in question ran up and hugged him. “How's Ash?”

“Got some good news. Your brother's gonna be fine,” she smiled down at the boy.

“Really?” Michael grinned.

“Yeah. Really. No one can explain it; it's a miracle. They're going to keep him overnight for observation, and then, he's coming home.”

You smiled as Sam asked, “How are all the other kids doing?”

“Good. Real good. A bunch of them should be checking out in a few days. Dr. Travis says the ward's going to be like a ghost town,” she explained.

“Dr. Travis? What about Dr. Hydecker?” you asked.

“Oh, he wasn't in today. Must have been sick or something.”

You shot a knowing look to the boys.

“So, did anything happen while I was gone?” Joanna asked her son.

The boy looked to Dean before responding, “Nah, same old stuff.”

“Okay.” Joanna smoothed a hand over Michael’s blonde hair. “You can go see Ash.”

A wide grin spread across the boy’s face. “Now?!”

She nodded at her son, who ran into the car. “I, ah, I'd better get going before he hotwires the car and drives himself,” she told you and the boys. The three of you watched as Joanna’s car pulled out of the parking lot. Sam and Dean turned to you and placed their bags in the trunk next to yours. 

“It's too bad,” said Sam.

“Oh, they’ll be fine,” you assured him.

“That's not what I meant,” he shook his head. “I meant Michael. He'll always know there are things out there in the dark— he'll never be the same, you know?” He paused. “Sometimes I wish that....”

“What?” Dean questioned.

“I wish I could have that kinda innocence.”

Dean walked to the driver’s side door. He leaned on the roof of the car and said, “If it means anything, sometimes I wish you could too.”

Series Rewrite Taglist: @polireader @brightlilith @atcamillanorrman @jrizzelle @insomnia-bookworm @procrastination20 @mrs-liebgott @djs8891 @tiggytaylor @staple-your-mouth @iloveshawn @jesstherebel @rach5ive @strawberrykiwisdogog @bruhidkjustwannaread @mxltifxnd0m @sunshine-on-marz @big-ol-boat @mgchaser @capncrankle @davina-clairee @chervbs @simpingdeadcharacters @nesnejwritings @stillhere197 @stephshaww @tearsforhan @take-it-on-the-run @iloveyou2mia @maxinehufflepuffprincess @ohgeehowdigethere @here-for-the-extravaganza @seninjakitey @berarenado @s0urw00lf @princessleahorgana @quarterhorse19 @rei0812 @isla-finke-blog @silverdoragon @karacaroldanvers @gayandfairycore @examishbookwyrm @more-espresso-less-depresso-og @mysticmyth @favoritefandoms27 @star-yawnznn

hi hi! quite a few tags were broken :( please let me know if i've misspelled your tag! make sure you have notifs for my blog on so you don't miss an update!

[kinardsevan]

so i have this other au that's been floating around in my head that I might not ever write, but I wonder if anyone else has it.

basically, knowing Buck was born as a savior sibling, I get this idea similar to My Sister's Keeper. in essence, Daniel still dies, but he dies after Evan's a little older. Maybe not that much older, but old enough that he remembers the procedures that Margaret insists on to save her oldest son. Buck gets put through all the needle sticks, bone marrow draws, etc., but obviously none of it works and eventually Daniel still passes, but this really drives a wedge between Buck and his parents. Maddie becomes that much more of the person Buck relies on because Margaret was always too busy worrying about Daniel to pay attention, and Philip just wanted her to be happy so he went along with it.

Except, things still kinda pan out the same way they already did. Buck was still young enough that mostly what he remembers is spending a lot of time in hospitals, but not really why. He remembers pain, but not much more than that. Maybe he doesn't even really remember Daniel, because he was always kept away from him due to neutropenia. And then when things come out about it when Maddie is pregnant with Jee-Yun, he kinda loses it.

Ultimately, he still meets Tommy, falls in love with him, etc. But Tommy sees how skittish he is with doctors, sees the scars (both from inadvertent self-harm to get his parents attention as well as maybe some from them taking cells, etc., for Daniel. headcanoning that maybe he has one from donating part of his liver or a kidney.)

But basically, the Buckleys want to work their way back into Evan's good graces, and Tommy isn't here for it at all because he can see the ways in which they abused their privilege of being parents on the son they only wanted for parts. This would all culminate in some level of an explosion at them. Maybe through it all, Evan has his own cancer scare, and Tommy snaps about who's going to show up and be his donor when they've already used up the pieces they wanted from him.

(I literally would name the fic spare parts. I got that far in plotting it in my head.)

thoughts?

[chronicallymistreated]

Lately I've also been feeling the effects of my chronic neutropenia, I've been really sick which was horrible. I've also realised I've dipped in and out of monocytopenia which is worrying but hopefully is just because of the low neutrophils.

[theskeptileptic]

My life is crazy and writing is slow, but I hope to be done with this chapter by Friday. Have a very tiny crumb!

(From a pending-not-yet-completed Ch. 27 of Northern Attitude)

————————————

SOAP:

Patient presented to hospital with GSW to spleen resulting in rupture, mild-to-moderate traumatic brain injury, ecchymosis of stomach, legs, contusions on neck, arms, abdomen, distal radius fracture and cardiac arrhythmia. He entered Gotham General ER accompanied by father and was promptly admitted for surgery.

Pt life-flighted to Gotham Children’s for acute care after concerns presented by GG medical team. GC admitted patient into PICU for critical illness. Immediate concerns include neutropenia, sepsis, and dyspnea—medical team elected for ventilator, broad spectrum IV antibiotics, among other interventions.

Pt is mostly unresponsive to RN, MD, and SW interactions, sleeping about 18 hours throughout the day, and demonstrating confusion when awake. Pt on feeding tube until able to self-feed. Visitors prohibited at this time, contact and droplet precautions required. Pt has strong support system, including father, three brothers, and a grandfather.

Pt’s youngest brother is currently admitted downstairs in PAC for bronchial pneumonia with pyrexia. Pt has extensive history of abuse from bio-mother and husband (both deceased). Bio-father has full custody.

Father demonstrates high levels of anxiety and concern for Pt and Pt’s brother resulting in conflict between doctors and family, intervention should include allowing father immediate, full-time access (with appropriate PPE) in Pt’s room, social services referral, and mental health referral.

Immediately moving Pt to youngest brother’s room when level of care eases is encouraged. Increased counseling with medical staff on complex grief, trauma, and family systems. When Pt is lucid, social service intervention includes active listening and age-appropriate counseling/explanation for upcoming internal fixation for wrist.

Pt’s prior history with social workers may be a challenge in earning trust. If this is the case, Social Services should find a trusted therapeutic contact to take over caseload as not to cause further anxiety. Referral to OT and PT pending. Possible animal, music therapy as Pt recovers, since youngest brother has also expressed interest.

This note is considered HIPAA protected information—as Pt’s family is high profile, it is important to document that any staff member leaking this to the press will be persecuted prosecuted by both the hospital and the Pt’s family. (Don’t even try it, assholes.) — Leslie Thompson, MD

[does-truth-matter]

The CDC has quietly changed who should AVOID the MMR vaccine.

https://www.cdc.gov/vaccines/vpd/mmr/public/index.html

They now state that ANYONE that “Has a parent, brother or sister with a history of immune system problems” should AVOID THE MMR VACCINE!

What exactly is an 'immune system problem?" Every autoimmune disorder.

* Achalasia

* Addison’s disease

* Adult Still's disease

* Agammaglobulinemia

* Alopecia areata

* Amyloidosis

* Amyotrophic lateral sclerosis (Lou Gehrigs)

* Ankylosing spondylitis

* Anti-GBM/Anti-TBM nephritis

* Antiphospholipid syndrome

* Autoimmune angioedema

* Autoimmune dysautonomia

* Autoimmune encephalomyelitis

* Autoimmune hepatitis

* Autoimmune inner ear disease (AIED)

* Autoimmune myocarditis

* Autoimmune oophoritis

* Autoimmune orchitis

* Autoimmune pancreatitis

* Autoimmune retinopathy

* Autoimmune urticaria

* Axonal & neuronal neuropathy (AMAN)

* Baló disease

* Behcet’s disease

* Benign mucosal pemphigoid

* Bullous pemphigoid

* Castleman disease (CD)

* Celiac disease

* Chagas disease

* Chronic inflammatory demyelinating polyneuropathy (CIDP)

* Chronic recurrent multifocal osteomyelitis (CRMO)

* Churg-Strauss Syndrome (CSS) or Eosinophilic Granulomatosis (EGPA)

* Cicatricial pemphigoid

* Cogan’s syndrome

* Cold agglutinin disease

* Congenital heart block

* Coxsackie myocarditis

* CREST syndrome

* Crohn’s disease

* Dermatitis herpetiformis

* Dermatomyositis

* Devic’s disease (neuromyelitis optica)

* Discoid lupus

* Dressler’s syndrome

* Endometriosis

* Eosinophilic esophagitis (EoE)

* Eosinophilic fasciitis

* Erythema nodosum

* Essential mixed cryoglobulinemia

* Evans syndrome

* Fibromyalgia

* Fibrosing alveolitis

* Giant cell arteritis (temporal arteritis)

* Giant cell myocarditis

* Glomerulonephritis

* Goodpasture’s syndrome

* Granulomatosis with Polyangiitis

* Graves’ disease

* Guillain-Barre syndrome

* Hashimoto’s thyroiditis

* Hemolytic anemia

* Henoch-Schonlein purpura (HSP)

* Herpes gestationis or pemphigoid gestationis (PG)

* Hidradenitis Suppurativa (HS) (Acne Inversa)

* Hypogammalglobulinemia

* IgA Nephropathy

* IgG4-related sclerosing disease

* Immune thrombocytopenic purpura (ITP)

* Inclusion body myositis (IBM)

* Interstitial cystitis (IC)

* Juvenile arthritis

* Juvenile diabetes (Type 1 diabetes)

* Juvenile myositis (JM)

* Kawasaki disease

* Lambert-Eaton syndrome

* Leukocytoclastic vasculitis

* Lichen planus

* Lichen sclerosus

* Ligneous conjunctivitis

* Linear IgA disease (LAD)

* Lupus

* Lyme disease chronic

* Meniere’s disease

* Microscopic polyangiitis (MPA)

* Mixed connective tissue disease (MCTD)

* Mooren’s ulcer

* Mucha-Habermann disease

* Multifocal Motor Neuropathy (MMN) or MMNCB

* Multiple sclerosis

* Myasthenia gravis

* Myositis

* Narcolepsy

* Neonatal Lupus

* Neuromyelitis optica

* Neutropenia

* Ocular cicatricial pemphigoid

* Optic neuritis

* Palindromic rheumatism (PR)

* PANDAS

* Parkinson's disease

* Paraneoplastic cerebellar degeneration (PCD)

* Paroxysmal nocturnal hemoglobinuria (PNH)

* Parry Romberg syndrome

* Pars planitis (peripheral uveitis)

* Parsonage-Turner syndrome

* Pemphigus

* Peripheral neuropathy

* Perivenous encephalomyelitis

* Pernicious anemia (PA)

* POEMS syndrome

* Polyarteritis nodosa

* Polyglandular syndromes type I, II, III

* Polymyalgia rheumatica

* Polymyositis

* Postmyocardial infarction syndrome

* Postpericardiotomy syndrome

* Primary biliary cirrhosis

* Primary sclerosing cholangitis

* Progesterone dermatitis

* Psoriasis

* Psoriatic arthritis

* Pure red cell aplasia (PRCA)

* Pyoderma gangrenosum

* Raynaud’s phenomenon

* Reactive Arthritis

* Reflex sympathetic dystrophy

* Relapsing polychondritis

* Restless legs syndrome (RLS)

* Retroperitoneal fibrosis

* Rheumatic fever

* Rheumatoid arthritis

* Sarcoidosis

* Schmidt syndrome

* Scleritis

* Scleroderma

* Sjögren’s syndrome

* Sperm & testicular autoimmunity

* Stiff person syndrome (SPS)

* Subacute bacterial endocarditis (SBE)

* Susac’s syndrome

* Sympathetic ophthalmia (SO)

* Takayasu’s arteritis

* Temporal arteritis/Giant cell arteritis

* Thrombocytopenic purpura (TTP)

* Tolosa-Hunt syndrome (THS)

* Transverse myelitis

* Type 1 diabetes

* Ulcerative colitis (UC)

* Undifferentiated connective tissue disease (UCTD)

* Uveitis

* Vasculitis

* Vitiligo

* Vogt-Koyanagi-Harada Disease

Wonder how many doctors are paying attention?

~shared from Jodi Wilson

[jartita-me-teneis]

Fue su última aparición en público. Y tal vez lo sabía. Un desmejorado Freddie Mercury sujetaba entre sus manos el galardón que acababa de recibir Queen en los Brit Awards, el 18 de febrero de 1990, por su contribución a la música británica. No dio un paso al frente de la banda -integrada por Brian May, en guitarra, Roger Taylor, batería y John Deacon en bajo- como acostumbraba. Los agradecimientos los dio May, luego de que el presentador del premio, Terry Ellis, presidente de la BPI (Industria Fonográfica Británica) se deshiciera en elogios con los miembros de la agrupación y reconociera de que estaban en deuda. “Son cuatro hombres, todos graduados universitarios, que este año celebran 20 años trabajando juntos… En verdad nunca han sido plenamente reconocidos por los logros sobresalientes de su impresionante carrera. Pero esta noche vamos a corregirlo”.

En la gala que tuvo lugar esa noche en el Dominion Theatre, en el West End londinense, Freddie Mercury estaba muy maquillado para disimular la palidez de la enfermedad de la que no quiso hablar hasta un día antes de su muerte. Todos los medios de prensa, sensacionalistas y los tradicionales, especulaban que había contraído el Síndrome de Inmuno Deficiencia Adquirida (Sida) llamada en esos tiempos “peste rosa”, pensando que era una enfermedad que solo golpeaba a la comunidad gay, a quienes se los acusaba como responsables de su aparición. El líder de Queen había bajado de peso repentinamente, se lo veía débil, pálido y era evidente de que algo malo le estaba pasando. Freddy Mercury era un frontman con una personalidad desbordante de energía, explosiva sobre el escenario, donde era común que interactuara con miles de personas. Hasta que todo cambió.

Comenzó a ocultarse de los medios que escarbaban sobre su vida privada y ya algo habían encontrado. Solo que no salía de su propia boca. Queen guardaba con máximo hermetismo un secreto que los llevó evitar las entrevistas, apariciones públicas y algo más llamativo: no salir de gira promocional por el lanzamiento de su álbum de 1989, The Miracle. La última gira que hicieron fue la de Magic Tour, para tocar el álbum A kind of Magic. Corría el año 1986 y se presentaban con el escenario y plataformas de luces más grandes que tuvieron en su carrera, además de una mega pantalla. En las dos fechas de Wembley, cuyas entradas se vendieron en 6 horas, hubo 15 cámaras y un helicóptero tomando vistas aéreas, sobre las 75 mil personas que vieron el espectáculo.

Esa noche de los Brit Awards era una sombra de sí mismo. Llevaba un traje cruzado, color celeste, cuando él acostumbraba llevar mallas pegadas al cuerpo, camisetas escotadas que dejaban ver sus brazos marcados por algún brazalete. Usaba colores vibrantes como el rojo o el amarillo. Esta vez para disimular su delgadez extrema, optó por esa prenda holgada, que a su vez revelaba su estado anímico. Freddie Mercury se había apagado, tenía la mirada ausente, seguramente sumido en sus pensamientos. Quien contraía el virus del HIV lo vivía como una sentencia a muerte, porque todos terminaban muriendo. No había escapatoria. Porque en esos tiempos, no tenía chances de salvarse. Y morían en soledad en un hospital, porque era una enfermedad estigmatizante. Los efectos adversos de la medicación, la zidovudina ( AZT), un viejo fármaco para el cáncer que descubrieron que retrasaba las infecciones, generaba náuseas, vómitos, problemas en la sangre (anemia y neutropenia) y debilidad muscular (miopatía). Algunas personas que sobrevivieron a la enfermedad en esa época cuentan que tomaban unas 18 pastillas. En las internaciones, se enteraban de cómo iban muriendo día a día gente muy joven, llena de sueños y proyectos, como los tendría Freddie, en la cima de su carrera.

El líder de Queen asumió esa noche un rol secundario, mientras sostenía el galardón con casco de gladiador y tridente. Estaba en otra parte. Apenas se rió cuando Brian May, después de los agradecimientos se animó a deslizar un chiste, tal vez con la idea de descomprimir el drama que callaban. “Quisiera dar un especial agradecimiento a la industria petrolera británica por este magnífico premio en reconocimiento a toda la cantidad de vinilo que hemos reciclamos a lo largo de los años”, dijo el astrofísico de la banda y la audiencia se lo festejó. Finalmente, luego de que Taylor y Deacon saludaran brevemente, Mercury tomó el micrófono y se limitó a decir tres palabras: “Gracias. Buenas noches”. Lo último que pudo decirle a su público en lo que fue la última presentación de la banda sobre un escenario.

Después de la entrega de los Brit Awards hubo una fiesta, donde Freddie se tomó fotos con las velitas para celebrar los 20 años de Queen, y junto con otras de las estrellas de la música, que habían sido nominados o premiados esa noche. Las imágenes, muestran el deterioro físico de Freddie, pero también el gran afecto y admiración de sus amigos en el ambiente de la música. Hay fotos con David Gilmour, Rod Stewart, Liza Minnelli y George Michael (1963-2016). Este último fue uno de los músicos que después de la muerte de Freddie, participó del tributo que le hicieron en 2013 con un Somebody To love memorable, sin que nadie pudiera imaginar tres años después sería encontrado muerto en su cama por una falla en su corazón. The Freddie Mercury Tribute Concert for AIDS Awareness, tuvo lugar en el estadio de Wembley el 20 de abril de 1992, al cumplirse solo cinco meses de la muerte del cantante. El objetivo del recital, que reunió 72 mil asistentes, fue cumplir con uno de los pedidos del Mercury, generar conciencia sobre la existencia del sida y juntar fondos para la Mercury Phoenix Trust, la fundación que creó el resto de la banda tras su muerte.

En mayo de 1987 los medios comenzaron a acecharlo desde el momento en que su ex manager y amante, Paul Brenter, en una actitud de despecho, vendió fotos de la intimidad de la estrella cuando nunca había salido del closet. Había contado que había tenido sexo con más de 100 hombres y que sus dos últimos amantes habían muerto a causa del Sida. Era una bomba, ya que era una época en que reinaba la homofobia, que The Sun dosificó en diferentes ediciones. Todo esto le habría reportado a Paul Prenter unos 100 mil dólares, según contó Jim Hutton, la última pareja del vocalista de Queen. Algo por lo que más tarde se mostró arrepentido y el cantante, no estuvo dispuesto a perdonar.

infobae

Después de la gala de los Brit Awards, el creador de Bohemian Rhapsody se recluyó en su casa londinense y siguió dando batalla a su enfermedad en pie. Trabajó hasta donde le dieron sus fuerzas. En febrero de 1991 se lanzó su último álbum, Innuendo. Los rumores continuaban alimentándose porque esa noche Mercury faltó a la cita. Era evidente el avance de la enfermedad, además de los esfuerzos que hacía la banda para maquillar la realidad. Los videos I’m Going Slightly Mad y These Are The Days Of Our Lives están grabados en blanco y negro, para disimular el deterioro de Freddie.

Freddie Mercury murió en su cama, en su hogar de Kensington en Londres, a los 45 años, rodeado de sus afectos. Su pareja, el peluquero Jim Hutton y su ex novia y mejor amiga, Mary Austin a quien le dejó la mitad se su fortuna. Días antes de su muerte, el líder de una de las bandas británicas más famosas de todos los tiempos consultó a su representante Jim Beach sobre cómo contarle al mundo que se estaba muriendo. No podía irse sin decir nada. Y así lo contó, por medio el manager: “Respondiendo a las informaciones y conjeturas que sobre mí han aparecido en la prensa desde hace dos semanas, deseo confirmar que he dado positivo en las pruebas del virus y que tengo sida. Es hora de que mis amigos y mis fans en todo el mundo sepan la verdad y deseo que todos se unan a mí, a mis médicos y a todos los que padecen esta terrible enfermedad para luchar contra ella”. A las 24 horas de ese anuncio, un 24 de noviembre de 1991, el artista moría de una bronconeumonía, una complicación generada por el sida. Su funeral fue una ceremonia íntima, solo asistieron familiares y amigos, no más de 35 personas, y tuvo lugar en el crematorio West London, dentro del cementerio Kensal Green. Todavía no se sabe bien cual fue el destino de sus cenizas. Se cree que fueron esparcidas por Mary Austin en el lago Lemán en Ginebra, Suiza, donde Mercury pasó parte de sus últimos años. Otros creen que fueron repartidas en diferentes teatros. O que están en su mansión de Kensington.

Vía: https://www.infobae.com/

[unibytekids]

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[loreandtempo]

Straight Outta Neutrophils

Back in July, when I was dealing with a sick 9 month baby, I had never heard of neutrophils.  Three months on, my learner plates have come off, so to speak, as I’ve learned a whole lot more about them. I’m currently coming to terms with the fact that, Kaydence has got a rare blood disorder called Severe Chronic Neutropenia (SCN). Which is also a rare type of primary immunodeficiency. And what I…

[appalachiananarchist]

My immunoglobulins have been on a steady downward trend and I am worried I'll have to stop rituxan in the near future because of it. My IgM is down much lower than before, though IgG is holding steady. Rituxan has given me so much of my life back when little else was working, so the thought of losing it is upsetting. I don't have to worry quite yet, though. I don't think they are low enough to stop my infusion next week. My WBCs are actually pretty good at 3, though my neutrophils and lymphocytes are still down.

I just hate that my condition, if untreated, causes me to have concerningly low white cells/neutropenia The treatment for my condition, which makes those numbers a little better, messes with the Ig levels. There is no way out of this that doesn't involve my immune system taking a hit.

My platelets and RBCs are good though! I've been bruising a lot so I was worried about the platelets, but we're all good. Kidneys are also being troopers as always. Major shout out to my kidneys, which have weathered everything like champs.

[nightingalesandnorco]

Hi! Just found your blog and I think I’m in love, this is my new holy grail.

Could you give me a quick rundown of procedures that have to do with bone marrow? What are they, why are they done, etc.

PS: is there any niche topic you’ve been wanting to mention but have never been asked about? If so, now’s your chance to nerd out! :)

- 🦾

Oh dear anon, you've just activated me like a sleeper agent... I've already done a ton of research on bone marrow procedures for a whumpy daydream, and I just learned about it in school. Little did you know, this is the niche topic that I could talk about for days.

Bone marrow, baby!

So bone marrow in the innermost part of the bones and is most abundant in the long bones (femurs, humeruses, radiuses, ulnas, tibias, and fibulas) and pelvis. The primary function of bone marrow is to produce blood cells, including erythrocytes (red blood cells [RBCs]), leukocytes (white blood cells [WBCs]), and platelets). RBCs carry oxygen, WBCs fight infections, and platelets clump together to form clots and stop bleeding. The bone marrow cells that produce these blood cells are called hematopoietic [he-MAT-o-po-EE-tic] stem cells.

Bone marrow dysfunction can manifest in clinical disorders such as anemias (sickle cell, beta thalassemia, aplastic), malignancies (leukemia, myeloma, lymphoma, polycythemia vera), and other non-anemia deficiencies (leukopenia [deficiency of WBCs], neutropenia [deficiency of neutrophils, a type of WBC], thrombocytopenia [deficiency of platelets]). These disorders can co-occur and result from each other. Some medications like chemotherapy and some anti-infectives can also suppress the bone marrow.

Procedures involving the bone marrow include aspiration and biopsy, donation, and transplant.

Bone marrow aspiration and biopsy: This is a procedure to take a sample of the bone marrow for the purposes of diagnosing any of the above disorders. It is not performed if the patient has bleeding disorders like hemophilia. This is usually an outpatient procedure done in an interventional radiology (procedures are guided by x-ray or other imaging methods) unit. The patient will be admitted to the unit and asked to change into a gown, then will get an IV and have a full set of vitals taken (temperature, heart rate, respiratory rate, blood pressure, oxygen saturation). They will be asked to sign a consent form after the procedure and its risks and benefits have been explained. When it's time for their procedure, the patient will be wheeled in a hospital bed to the procedure room (see the image below) by a nurse.

All staff involved in the procedure will be wearing lead-lined aprons, surgical masks, and goggles. In the procedure room, they will move from the bed to a table, or will be assisted if needed, and positioned on their stomach with a pillow under their hips. They will be hooked up to a cardiac monitor and put on an end-tidal CO2 sampling nasal cannula (see the image below).

They may or may not be given fentanyl and midazolam (Versed) through their IV for pain relief and mild sedation. They will still be awake and aware during the procedure. I've seen people make small talk with the staff for their entire procedures. The patient will then be draped everywhere except for the site (over one of the iliac crests of the pelvis) of the procedure. The radiologist will inject lidocaine into the skin around the site and clean it with betadine (a disinfectant similar to iodine). The radiologist will then make a small incision at the site and insert a needle containing a fine tube down to the bone (see the image below).

The radiologist will work the needle into the bone with a twisting motion. The patient won't feel pain, but some people have said that the sensation of the needle twisting into the bone can be uncomfortable. When the needle penetrates the marrow, it will be removed, leaving the tube to which a syringe will be attached and marrow drawn up. Patients have reported feeling an uncomfortable sucking sensation during this part. Once this is done, the tube will be removed and a biopsy needle (see the image below) will be inserted into the same incision to take a separate sample.

A twisting motion is also used here. The radiologist will then put a pressure dressing on the site. After the radiological equipment has been turned off and the patient disconnected from the monitoring equipment, the staff will move them back to the hospital bed and the nurse will wheel them back to their cubicle in the unit. They will be positioned so that their weight is on the incision to maintain pressure and control bleeding. The patient will stay at the hospital for a few hours while the meds wear off and the nurses monitor them for bleeding, after which they will be discharged with instructions to call the doctor if they experience any excessive bleeding. They should have someone else drive them home.

Bone marrow donation: To be a bone marrow donor, a person has to be between 18 and 35 years old; not have HIV/AIDs, rheumatoid arthritis, systemic autoimmune diseases, bleeding disorders, brain injury, cancer or prior cancer treatments within 5 years of the donation, chronic pain that is treated with medications, chronic Lyme disease, diabetes that requires insulin, heart disease, hepatitis B/C, or kidney disease; and be a match to the intended recipient's human leukocyte antigen (HLA) and blood type. (Note: people can donate to bone marrow banks and be matched anonymously to recipients with their same HLA type) HLA types are different from blood types and are most commonly matched between people of the same ethnic background and family members, especially siblings. The donor will have to undergo extensive tests to ensure that they are healthy enough to undergo the procedure and for their bone marrow to be used for transplant; these include blood tests, tests for all types of infections, an electrocardiogram, and a chest x-ray. Bone marrow stem cells may be harvested from a regular blood donation or from bone marrow aspiration. The procedure for donation is the same as for aspiration, only the patient may be put under general anesthesia and intubated and the doctor will pull off about 1-2 pints of bone marrow. The patient may have to stay in the hospital overnight.

Bone marrow transplant: This is officially called a hematopoietic stem cell transplant (HSCT) and is usually done for leukemia, lymphoma, myeloma, polycythemia vera, aplastic anemia, severe immunodeficiency disorders, sickle cell anemia, beta thalassemia, and other disorders of the bone marrow or immunity. Stem cells can be taken from the recipient before their illness became serious, a related or unrelated donor, or umbilical cord blood. It is often a last resort treatment due to its high cost (up to $500,000) and potential for graft rejection. Before transplantation, the patient will receive high-dose radiation and chemotherapy (myeloablative therapy) to destroy their existing bone marrow. Once the myeloablative therapy has been completed, stem cells will be infused through a central venous catheter (see the image below), which the patient will certainly already have if they have cancer.

Ideally, the cells will seed in the bones and multiply to fill them (engraftment). This can take 2-4 weeks, or may never occur. The patient may not achieve full immunity for months or years. The patient may be in the hospital from the start of myeloablative therapy to 100 days after the transplant. Following the transplant, the patient will be on a regimen of medications to suppress their immune system to avoid graft-versus-host disease (GVHD; rejection of the donor stem cells resulting in a systemic inflammatory reaction). The patient may or may not be on this regimen for the rest of their life; if they never experience GVHD, they may not. They will have to be on the lookout for signs of graft rejection and secondary cancers (due to the myeloablative therapy) for the rest of their life.

Thanks for letting me nerd out and happy whumping!