Objective To investigate the safety of erythrocytapheresis in patients with high altitude polycythemia undergoing arthroplasty and the effectiveness of reducing the incidence of lower extremity deep vein thrombosis(DVT).Methods A retrospective analysis was carried out focusing on the clinical data of 45 Tibetan male patients who underwent total hip arthroplasty(THA) and total knee arthroplasty (TKA) in the Department of Orthopaedics of our hospital from October 2018 to August 2020.Of the enrolled 45 patients,34 cases underwent THA and the other 11 cases were provided with TKA.The average age was (51.40±13.29) years old (ranging:31 to 73).The body mass index(BMI) was 21.79~33.79 kg/m2,with a mean BMI of (28.69±3.05) kg/m2;and the mean preoperative hemoglobin was (215.10±17.92)g/L,with a mean value of 191.00~249.00 g/L.In addition,the indication of preoperative therapeutic erythrocytapheresis was Hb>190g/L.Blood samples were taken for routine blood test prior to and on the second day of erythrocytapheresis,the first day and the third day after the operation to observe the changes of red blood cell count(RBC),hemoglobin(Hb) and hematocrit(Hct).Meanwhile,D-Dimer was detected by blood sampling before erythrocytapheresis and the first day after operation to observe the change of D-Dimer.All patients were examined by color Doppler ultrasound of of veins of both lower extremities routinely for DVT screening before and 1,3,7,14,35 days after operation.Results Routine blood test:RBC was tested to be(5.89~8.70)×1012/L and(3.84~6.63)×1012/L before and after erythrocytapheresis,with a mean value of (6.85±0.95)×1012/L and (5.30±0.75)×1012/L,respectively;besides,it was (3.21~6.18)×1012/L and (3.25~6.10)×1012/L one day and three day after operation,with the mean value of (4.76±0.89)×1012/L and (4.28±0.98)×1012/L,respectively.There was statistical difference between the values after single-harvest,postoperative day 1,postoperative day 3 and before single-harvest (P<0.05).Hb was 191.00~249.00 g/L and 133.00~191.00 g/L before erythrocytapheresis and after erythrocytapheresis,with the mean Hb of(215.10±17.92)g/L and (167.60±16.26)g/L,respectively;in addition,it was 109.00~180.00 g/L and 108.00~175.00 g/L 1 day and 3 day after operation,with the mean Hb of(150.67±21.95)g/L and(133.00±24.15)g/L,respectively;and the difference was statistically significant between the values after single-harvest,postoperative day 1,postoperative day 3 and before single-harvest(P<0.05).Hct was detected to be 57.70%~72.80% and 38.90%~57.30% before erythrocytapheresis and after erythrocytapheresis,with a mean value of (62.73±5.24)% and (49.45±4.93)%,respectively;and it was 32.10%~52.70% and 32.30%~50.20% one day and three day after operation,with the mean value of (44.11±5.94)% and (38.70±6.52)%,respectively,with statistically significant difference between the values after single-harvest,postoperative day 1,postoperative day 3 and before single-harvest (P<0.05).2.D-Dimer was detected to be 0.01~1.20 mg/L and 2.37~6.07 mg/L before erythrocytapheresis and one day after operation,with the mean value of (0.28±0.45)mg/L and (4.04±1.54)mg/L,respectively;and the difference was statistically significant (P<0.05).3.In terms of DVT,one patient was found to have thrombosis of bilateral posterior tibial vein,left fibular vein and calf intermuscular vein on the first day after THA.In addition,there was no cases of pulmonary embolism and blood transfusion. Conclusion Erythrocytapheresis can be effective to reduce the incidence of DVT for the population with high altitude polycythemia in the perioperative period of arthroplasty.Besides,it is safe and reliable,exhibiting good clinical application value.
[1]Kehlet H.Fasttrack hip and knee arthroplasty[J].Lancet,2013,381(9878):1600-1602.
[2]中华医学会骨科学分会.中国骨科大手术静脉血栓栓塞症预防指南[J].中华骨科杂志,2016,(02):65-71.
[3]刘丽军,张致英,张寒,等.高原红细胞增多症相关蛋白因子和基因的研究进展[J].国外医学(医学地理分册),2019,40(2):204-208.
[4]邓立庆,冯品,甘彦峰,等.不使用止血带在全膝关节置换术中的临床效果评价[J].中国矫形外科杂志,2017,25(23):2186-2189.
[5]LeónVelarde F,Maggiorini M,Reeves JT,et al.Consensus statement on chronic and subacute high altitude diseases[J].High Alt Med Biol,2005,6(2):147-157.
[6]中华医学会第三次全国高原医学学术讨论会.我国高原病命名、分型及诊断标准[J].高原医学杂志,2010,20(1):9-11.
[7]邓立庆,余玲,冯品,等.藏族人群关节置换术后下肢深静脉血栓发生的时间分布[J].中国矫形外科杂志,2019,27(5):431-434.
[8]邓立庆,冯品,甘彦峰,等.藏族人群关节置换术后下肢深静脉血栓发生率及解剖分布[J].中国矫形外科杂志,2019,27(16):1446-1450.
[9]方洁,李啸扬,李军民,等.红细胞单采治疗高原红细胞增多症合并凝血功能异常的临床观察[J].实用心脑肺血管病杂志,2019,27(S2):38-40.
[10]李红梅,王远杰,刘方久,等.红细胞单采术治疗高原红细胞增多症疗效分析[J].检验医学与临床,2019,16(3):415-417.