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3.21 Family

The patient was a boy who needed to have his infection diagnosed and treated so he could donate bone marrow to his leukemia-stricken brother. While this analysis covers only one brother, in the final tally it counts as two patients.

Initial Symptoms: Boy with a sneeze + fever + enlarged spleen
Diagnosis: Histoplasmosis (Wilson+Foreman)

Contributions by Team
House (2): Idea to make patient sicker to diagnose him, idea to stop medication to figure out if it's infection that is suppressing bone marrow production
Chase (1): Sees elevated enzymes, leading to discovery of a fibrous growth in mitral valve
Cameron (0): None
Foreman (4): Insists on continuing testing for infections, idea to check home for source of infection, diagnosis for histoplasmosis, idea to do bone marrow transplant anyway

Notes: Wilson realized the growth in the patient's mitral valve was fibrous; I'm not sure if this was caused by the fungal infection or not, but it was implied so for this diagnosis I assumed it was.
Wilson pointed out that the patient's family shouldn't have a water pump in their backyard, leading Foreman to test for farm-related diseases. Therefore they shared the histoplasmosis diagnosis.
The 4/6 bone marrow transplant didn't seem to buy the leukemia patient time for a proper diagnosis, but did almost kill him. Foreman received an error as a result.
Foreman's idea to perform the bone marrow transplant after the diagnosis, while horrible in its execution, did save the life of the patient's brother after every other doctor had given up on him.



Anonymous Anonymous said...

I've gone through a bone marrow transplant myself, and this episode takes way too much liberty with sensationalizing the leukemia and the transplant.

Most importantly, bone marrow is hardly ever extracted the way Foreman did it. The 20ml biopsy needle he used would require 75 stabs to get the 1500ml minimum volume of marrow required for the transplant. It is in fact a simple procedure much like dialysis, where a few hours at a machine which centrifuges blood, skims stem cells and then returns the blood to the donor is all it takes. The donor has to take neupogen injections (self-administered, like insulin) for five days prior to overproduce the stem cells he/she will donate. Unfortunately, due to this episode, viewers will never think of registering for a bone marrow donation.

Other smaller things include:
- When the 4/6 unrelated donor marrow is used, the patient gets GVHD that is "killing him". As far as I know, once GVHD starts killing a patient, this isn't reversible by a better marrow transplant without first killing off all the previous marrow.
- There is a danger of the patient bleeding into the brain because of low platelets. A platelet transfusion (I've had a dozen or so over the treatment) puts a stop to spontaneous bleeding.
- Recovery is nowhere near as fast as is shown. It takes a 100 days after the transplant to determine that the patient is surviving it. When I watched this, I felt like a chump, having to wait while the brothers high-fived and went home.
- HLA matches for donors are done out of 10 factors, not 6 anymore. House's hospital is supposed to be cutting edge...

That said, please register for bone marrow donation. has the skinny on how easy it is to register and to donate, please don't let Foreman's procedure spook you. You could be the difference between life and death for many who can't get a matched sibling.

December 23, 2008 10:36 AM  

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