Chapter 57: Preparing for Treatment

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TruePurpleMK
999+ points2 days ago

OK I did some research https://www.quora.com/Why-cant-a-patient-receive-blood-from-a-family-member

Basically the white blood cells of the donor blood may see ALL of the hosts cells as "invaders" and attack (extremely small chance) But in a relatively healthy person who isn't immuno-compromised d the persons own white blood cells will fight it out with the donors white blood cells, under normal conditions the hosts will easily win the battle vastly outnumbering the donor white blood cells.

But if the donor is a extremely small chance that the donor and host white blood cells do not see each other as threats/invaders but the donor white blood cells may still see the hosts other cells and tissue as foreign and attack, without the hosts immune system protecting. This can be tested for. I assume as simple as mixing the blood together under a microscope strong enough to see this and seeing how the cells interact.

But, if the host is immuno-compromised then this "donor white blood cells left unchecked attacking host" is much more likely to happen and it will be irrelevant if it is a relative since no immune system. Maybe it would still matter a bit if he's just got a weaker immune system instead of a completely disabled one. There is method to prevent this from happening other than checking ahead of time for reaction, which is to treat the blood so to kill the white blood cells of the donor or separate out the components of the blood so no white blood cells are transfused. Otherwise just testing for this reaction. Considering the risk, the effort should be made to do this, and that would make it irrelevant if it were family donor or not.

In fact, higher compatibility "HLA" means less likely for there to be a issue if the blood has not been stripped of it's white blood cells (vast majority of modern blood donations are treated to remove the white blood cells) Thus it would be better to be a family member.

According to chatgpt the odds would be 1 in 500,000 to 1 in 1 million if not family members to 1 in 1 million to 1 in 5 million for a properly matched family blood transfusion. Of course the odds are zero if the blood was treated to remove the white blood cells.

So the story did get it wrong, just in a way I did not expect. The description of the concern is wrong and it's only a additional risk in someone with a working immune system and irrelevant if you kill or remove donor white blood cells which should be done anyway.

Also it seems there is difficulty in testing blood type without modern lab equipment and family member blood is much more likely to be compatible and would be your best bet
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- Bob (Rex Bones)TruePurpleMK
  999+ points1 day ago
  I actually don't know where to start with this comment. Quora is not a great source for researching (though if it's a professional they'll likely have a bunch of sources to read through which is much better) and ChatGPT is so abysmally wrong about many things it's almost not funny.
  
  Anyway, on the actual manga part, what he said is actually true. Transfusion-associated graft-versus-host disease is a serious risk and is almost always lethal (https://doi.org/10.1016/j.hoc.2016.01.012), so keeping it lower by not having a family member make a directed donation is better. Testing for if his brother and fathers' human leukocyte antigens to see if they're compatible usually requires a skin punch biopsy (taking some living skin cells to test for risk), and the most effective ways to get rid of leukocytes we have today are only so effective before they also get rid of too many erythrocytes (centrifuge+buffy-coat, freezing), or are otherwise impractical for the MC to achieve (gamma irradiation, filtration) (https://pmc.ncbi.nlm.nih.gov/articles/PMC4921955/).
  
  So no, he's actually correct in his risk assessment here and the risk of TA-GvH is worse in immunocompromised recipients (https://pubmed.ncbi.nlm.nih.gov/30855823) like his brother.
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  - TruePurpleMKBob (Rex Bones)
    999+ points1 day ago
    For this to be a issue as far as I can tell you need two things, tell me if you think I am wrong.
    
    1, The donor's white blood cells must see the hosts cells as a threat.
    2. The host's immune must not see the donors white blood cells as a threat or must be unable to respond to foreign white blood cells. The first part "not seeing the donors white blood cells as a threat" is higher with familial blood but irrelevant without a functioning immune system.
    
    Thus for someone without a immune system, ALL foreign white blood cells can become unchecked threats to the host. "risk of TA-GvH is worse in immunocompromised recipients" Yes, but not because of familial blood but because of lack of immune system. Lack of immune system increases the risk of everything but familial blood. Since no immune system means only first point matters, "donors white blood cell's must see host as threats" then familial blood reduces risk since closer matches mean less risk of donor white blood cells attacking.
    "most effective ways to get rid of leukocytes we have today are only so effective before they also get rid of too many erythrocytes (centrifuge+buffy-coat, freezing"
    
    AKA Leukoreduction AKA remove the white blood cells from the donor blood. MC should do that and it will reduce the risk. How much, hard to say- Suffice to say my previous points remain. Without a immune system the issue becomes any donor bloods Leukocytes, not just familial.
    
    https://www.sciencedirect.com/science/article/abs/pii/S1473050222000647
    
    All that is left once you remove donor white blood cells is better match with close family members. Donated blood can have delayed rejection issues well down the road that you can not test for, familial blood reduces this risk.
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- SunDamselTruePurpleMK OK I did some research https://www.quora.com/Why-cant-a-patient-receive-blood-from-a-family-member...
  999+ points2 days ago
  It might be something specific to leukemia. idk though, I don't know anything about leukemia, most of my medical knowledge is related to my conditions and not cancer or blood transfusions.
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- bladexp210TruePurpleMK OK I did some research https://www.quora.com/Why-cant-a-patient-receive-blood-from-a-family-member...
  622 points2 days ago
  It can actually happen: https://www.msdmanuals.com/professional/hematology-and-oncology/transfusion-medicine/complications-of-transfusion
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  - TruePurpleMKbladexp210
    999+ points2 days ago
    Yeah it's possible. But lack of immune system or weaker immune system makes it more irrelevant. Since the issue is the hosts immune system not seeing the donor white blood cells as a threat. But the donor white blood cells seeing the hosts cells as a threat. A extremely unlikely but possible scenario. With less immune system response in the first place this becomes less relevant. In fact close relative compatibility just makes the donor white blood cells less likely to attack the host in the first place.
    
    MC needs to separate out the donated blood removing white blood cells using some kind of centrifuge machine (maybe using a bicycle powered setup since no motors, or using magic powers to spin it). This should be done anyways to avoid all sorts of potential problems, especially with a patient with a weakened immune system. That will help with all risk to TAGVH family or not
    
    The bigger issue is that MC lacks means to properly test blood types and is limited in blood testing compatibility. Family blood is most likely to be compatible and would best to be used in this scenario. Sibling would be best as that is the likely closest match. Though MC's weird properties probably mean sister would be the best donor candidate, assuming full siblings.
    
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Mint Blancmanche
999+ points2 days ago
zzzzzzzzzzzzzz
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- Ballsdeep69Mint Blancmanche
  999+ points2 days ago
  While I understand your sentiment - I would describe half the series as basically just being this, like it hasn't suddenly gotten boring it has consistently had bouts of dry text heavy medical drama this whole time.
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- Demonh8Mint Blancmanchezzzzzzzzzzzzzz
  999+ points2 days ago
  go watch naruto kid, or one piece, that's more into your mind age
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  - Mint BlancmancheDemonh8
    999+ points2 days ago
    never watched that crap and I'm 40yo, you are not on 4chan, no need to act like a spoiled brat.
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    - S
      SpongeJoeRoundPantsMint Blancmanche
      999+ points1 day ago
      Ahhh. A fellow 40yo
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    - Demonh8Mint Blancmanchenever watched that crap and I'm 40yo, you are not on 4chan, no need to act like a spoiled brat.
      999+ points2 days ago
      40 still a baby from my point of view
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      - S
        SpongeJoeRoundPantsDemonh8
        999+ points1 day ago
        Damn. How old are you then
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        Demonh8SpongeJoeRoundPants
        999+ points1 day ago
        old enough to have dated your grandma when she was a hottie, and yes, typing kinda hurts
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        SpongeJoeRoundPantsDemonh8
        999+ points13 hours ago
        Hahaha. Good ol boomer humour
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        Demonh8SpongeJoeRoundPants
        999+ points11 hours ago
        Humor, Arthritis, same stuff XD
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- Han YoojinMint Blancmanchezzzzzzzzzzzzzz
  999+ points1 day ago
  The whole series is like this, if you don't like it why are you here? ? 🙄
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  - Mint BlancmancheHan Yoojin
    999+ points1 day ago
    it's gotten boring, that's what I mean. this whole stupid shit "hurrr durrr I'm strong as shit but don't want anyone to know, oh noes not my brother xD"
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- JasherMint Blancmanchezzzzzzzzzzzzzz
  628 points11 hours ago
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  - Mint BlancmancheJasher
    999+ points7 hours ago
    ?
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userofthedegeneratearts
143 points15 hours ago
loved the med discussion in the comments, they even have sources, like a total chads
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- Ghostgemaruserofthedegeneratearts
  116 points15 hours ago
  Even if I don't know anything, the way commenters explain all the medical knowledge here just make the manga more understandable about the challenges of the medical world
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Latest Comments

If you really think about it there are no discrepancies.
The guy is now treating the MC special because he sees a very high potential.
The MC wasn't that impressive in his first life. As a kid he didn't even make it in that river. So he never managed to impress Hugo in a way that will treat him special.
Hugo really doesn't care who or were you are from, is not that he tried to keep him down in first life. Is just the rules of the house that didn't allow him certain privileges.
The only way to get around such rules is if Hugo treated him special and gave him access to more things than the rules normally allowed.

Hugo will only do that though if he sees a purpose of doing so. If he doesn't consider you anything special he sees no point in violating the rules for you since even if you get a little stronger you will still be nothing impressive in his eyes. He will only do it if he thinks that you are really special. And that is what he thinks about the current MC but not the one in his first life.

This chapter was all over the place.

Lili made the right call breaking up with Hiromi. I’ve been saying this for 10 chapters — ever since he broke up with Chika. He needed to take a step back and focus on growth before rushing into something new. But he didn’t. He jumped into a relationship with Lili and let his emotions take over.

That said, any guy in his situation would’ve felt some type of way. If your girl doesn’t come home, isn’t answering her phone, and just so happens to be with the guy you’re worried about… of course, you’d be upset. Hiromi tried to keep it together — and rightfully so. He had every reason to be mad. He took the high road when it could’ve gone left. That showed growth.

Where he went wrong was in what he said — he knows it, and Lili knows it. But here’s my issue: Hiromi had already told Lili he had a problem with her “friendship” with Hodoka. She was the one who said there was nothing to worry about. Yet, when she stayed at this man's house all night without calling, how was he supposed to feel? When he went to the art exhibit and heard her friends questioning if she and Hodoka were a couple, how was he supposed to feel? And finally, when his sharemates told her, “You and Hodoka would make a great couple,” how is he supposed to react? Anyone would’ve felt some type of way.

Lili was right to break up, but Hiromi needs to reflect and realize he still has some growing to do. The problem is… he’s got a terrible best friend. Instead of helping him reflect, he lets Hiromi blame himself and throws him on a dating app like that’s going to fix anything. That was weird.

I’ll give Lili credit — she owned her part. At least they both took accountability, and I respect that. But they still don’t need to be together. If your first instinct is to break up instead of working things out, y’all don’t belong together.

Especially after she said, “I can’t see us like that right now.” That should’ve been Hiromi’s cue to let her go for good. I’m glad they broke up. I hope they never get back together. She’s not ready for that kind of relationship, and he’s not ready to invest like that. It’s just not it.

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