Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Shigatse People's Hospital, Tibet, China.
Wilderness Environ Med. 2020 Dec;31(4):426-430. doi: 10.1016/j.wem.2020.07.006. Epub 2020 Oct 29.
High altitude polycythemia (HAPC) is a common chronic disease at high altitudes. It is characterized by excessive erythrocytosis (≥190 g·L in females or ≥210 g·L in males). HAPC severely jeopardizes the health status of plateau dwellers. The Qinghai-Tibet plateau, with an elevation above 4000 m, is the highest plateau in the world. Both Han and Tibetan populations residing there face the threat of HAPC. Therapeutic erythrocytapheresis (TE) was introduced to Tibet as an alternative to phlebotomy in 2015.
In this study, we retrospectively analyzed 155 patients with HAPC treated with TE in Tibet. Routine blood testing values before and after TE were compared to evaluate treatment efficacy. The efficiency rate, defined as the rate of increase in red blood cell depletion attained by TE compared with 450 mL whole blood phlebotomy, was calculated using whole blood volume and hematocrit before and after treatment and used to identify patients who maintained a normal hemoglobin level in the year after the TE procedure.
On average, TE reduced red blood cell levels by 1.5×10·L, hemoglobin concentration by 52 g·L, and hematocrit by 14% (P<0.001 for each). Patients who underwent TE with an efficiency rate ≥1.9 were more likely to maintain a normal hemoglobin level in the following year than those who underwent TE with an efficiency rate <1.9 (90 vs 28%, P<0.01).
TE is a feasible therapeutic method to treat HAPC on the Qinghai-Tibet plateau. The efficiency rate is a useful tool to predict the expected interval between TE procedures.
高原红细胞增多症（HAPC）是高原地区的一种常见慢性疾病。其特征为红细胞过度增生（女性≥190 g·L，男性≥210 g·L）。HAPC 严重危害高原居民的健康状况。海拔 4000 米以上的青藏高原是世界上海拔最高的高原。居住在那里的汉族和藏族居民都面临着 HAPC 的威胁。治疗性红细胞单采术（TE）于 2015 年被引入西藏，作为放血疗法的替代方法。
本研究回顾性分析了 155 例在西藏接受 TE 治疗的 HAPC 患者。比较 TE 前后常规血液检测值，以评估治疗效果。采用治疗前后全血体积和血细胞比容计算红细胞耗竭增加的效率率，并将其定义为 TE 与 450 mL 全血放血相比的增加率，以确定 TE 后一年内维持血红蛋白水平正常的患者。
TE 平均降低红细胞 1.5×10·L、血红蛋白浓度 52 g·L 和血细胞比容 14%（P<0.001）。效率率≥1.9 的患者在 TE 后一年内更有可能维持血红蛋白水平正常，而效率率<1.9 的患者则不然（90%比 28%，P<0.01）。
TE 是治疗青藏高原 HAPC 的一种可行的治疗方法。效率率是预测 TE 间隔时间的有用工具。
