Bone marrow metastasis of gastric signet ring cell carcinoma complicated by thrombotic microangiopathy: A case report

Table 3 Stratified management by organ system and core pathological mechanisms

Functional category	Drug	Dosage/administration	Mechanism of action
Blood component replacement	Leukocyte-depleted RBCs	17.5 U, IV infusion	Corrects anemia, improves tissue oxygenation
	Platelets	10 therapeutic units, IV infusion	Prevents thrombocytopenic bleeding
Hematopoietic regulation	Recombinant TPO	15000 U, IV infusion	Stimulates megakaryocyte differentiation
Coagulation correction	Human fibrinogen	2 g, IV infusion	Replenishes clotting factor I
Immunosuppression	Methylprednisolone sodium succinate	40 mg/day, IV infusion	Suppresses antibody-mediated RBC destruction
Capillary hemostasis	Carbazochrome sodium sulfonate	80 mg/day, IV infusion	Reduces vascular permeability
Hepatobiliary protection	Compound glycyrrhizin	120 mg/day, IV infusion	Anti-inflammatory, stabilizes hepatocytes
	Ursodeoxycholic acid	0.25 g, twice daily, per os	Promotes bile excretion
GI motility regulation	Mosapride citrate	5 mg, three times daily, per os	5-HT4 receptor agonist
	Omeprazole	1 g/day, IV infusion	Proton pump inhibitor
Broad-spectrum antibiotics	Ceftazidime	2 g, twice daily, IV infusion	Covers gram-negative bacteria
	Ornidazole	1 g/day, IV infusion	Targets anaerobes/protozoa
Bone protection	Zoledronic acid	4 mg/day, IV infusion	Inhibits osteoclast activity
Analgesic ladder	Tramadol ER	100 mg, every 12 hours, per os	Weak opioid + monoamine reuptake inhibition
	Morphine	3 mg/day, IV infusion	Central α-opioid agonist

RBC: Red blood cell; TPO: Thrombopoietin; GI: Gastrointestinal; ER: Extended release.