Department of Orthopedic Surgery, Nanjing Jinling Hospital, 305 Zhongshan East Road, Nanjing 210002, China.
Med Hypotheses. 2013 Jul;81(1):104-7. doi: 10.1016/j.mehy.2013.03.038. Epub 2013 Apr 23.
Hidden blood loss (HBL), commonly seen post total knee or hip arthroplasty, causes postoperative anemia even after reinfusion or blood transfusion based on the visible blood loss volume. The mechanism of HBL remains unclear although more than one theory had tried to explain it. Free fatty acids, metabolites of fatty emboli that are generated during TKA, THA and other surgery manipulating the medullary canal of femur, had been demonstrated to stimulate the neutrophils in producing reactive oxygen species such (ROS) as hydrogen peroxide and chlorous peroxide. Erythrocytes injury was also shown in parasitic infection, chronic renal disease and paroxysmal nocturnal hemoglobinuria in a mechanism of oxidation of membrane polyunsaturated fatty acids and cytosolic hemoglobin by ROS. Based on these results we hypothesize that free fatty acids generated from fatty emboli in blood circulation are responsible for the hidden blood loss through peroxidating injury of membrane molecules of RBC and hemoglobin. Antioxidants administered intra- or post-operatively are predicted to play a protective role in erythrocytes oxidation and potentially reduce the volume of hidden blood loss after arthroplasty.
隐性失血（HBL）在全膝关节或髋关节置换术后很常见，即使根据可见失血量进行了再输血或输血，也会导致术后贫血。尽管有多种理论试图解释 HBL 的发生机制，但它仍然不明确。游离脂肪酸是在 TKA、THA 和其他手术中操作股骨髓腔时产生的脂肪栓塞的代谢产物，已被证明可刺激中性粒细胞产生活性氧物质（ROS），如过氧化氢和亚氯酸过氧化物。在寄生虫感染、慢性肾病和阵发性夜间血红蛋白尿中，膜多不饱和脂肪酸和胞质血红蛋白的氧化也显示出红细胞损伤，其机制是 ROS 氧化。基于这些结果，我们假设循环血液中的脂肪栓塞产生的游离脂肪酸通过过氧化损伤 RBC 和血红蛋白的膜分子导致隐性失血。预计术后或术后给予抗氧化剂在红细胞氧化中发挥保护作用，并可能减少关节置换术后的隐性失血量。
