Application of apheresis autologous red blood cell transfusion in total hip arthroplasty

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Objective To investigate the application of apheresis autologous red blood cell transfusion technology in total hip arthroplasty (THA). Methods From February to July 2016, a total of 191 patients who received THA treatment in the Chinese PLA General Hospital were selected as the research subjects. All patients were randomly divided into study group (n=91) and control group (n=100) by simple random sampling method. Patients in the study group received autologous red blood cell apheresis before THA, while the control group did not collect any autologous blood before THA. The main blood indicators, including red blood cell count, levels of hemoglobin (Hb), white blood cell count, platelet count, were recorded before apheresis in study group or before THA in control group, as well as on the 1st and 3rd day after THA in the 2 groups, respectively. The amount of blood loss during THA, allogeneic transfusion volume on the day of THA, allogeneic blood transfusion rate, allogeneic red blood cell transfusion volume, allogeneic red blood cell transfusion rate, allogeneic plasma transfusion volume, and allogeneic plasma transfusion rate were also observed. Mann-Whitney U test, Wilcoxon signed rank test or χ2 test were used to compare the difference of the above indications between the patients of 2 groups. The procedure of this study is in accordance with the requirements of the revised World Medical Association Declaration of Helsinki in 2013. Informed consent was obtained from each patient. Results ① In this study, there were no statistically significant differences in median red blood cell count of patients between study group before apheresis and that of control group before THA, as well as those of patients between the 2 groups on the 1st and 3rd day after THA (P>0.05). In study group, the median red blood cell count of patients before apheresis was higher than that of patients on the 1st and 3rd day after THA, and the differences were statistically significant (4.5×1012/L vs 4.1×1012/L, Z=-4.043, P 0.05). On the 1st day after THA, the median Hb level of patients in study group was 125 g/L (113-134 g/L), which was higher than 115 g/L (107-135 g/L) of patients in control group, and the difference was statistically significant (Z=-2.302, P=0.021). In study group, the median Hb level of patients before apheresis was higher than those of patients on the 1st and 3rd day after THA, and the differences were statistically significant (137 g/L vs 125 g/L, Z=-6.668, P 0.05). On the 1st day after THA, the median white blood cell count of patients in study group was 11.34×109/L (9.75×109/L-12.76×109/L), which was higher than 10.20×109/L (8.50×109/L-12.39×109/L) in control group, and the difference was statistically significant (Z=-2.399, P=0.016). In study group, the median white blood cell count of patients on the 1st day after THA was higher than those of patients before THA and on the 3rd day after THA, and the differences were statistically significant (11.34×109/L vs 6.15×109/L, Z=-8.272, P 0.05). In study group, the median platelet count of patients before apheresis was higher than those of patients on the 1st and 3rd day after THA, and the differences were statistically significant (229×109/L vs 183×109/L, Z=-7.796, P 0.05). The median volume of allogeneic blood transfusion of patients in study group was 2.6 U (1.0-4.4 U), which was lower than 5.3 U (3.0-7.2 U) of patients in control group, and the difference was statistically significant (Z=-3.903, P 0.05). The rate of allogenic red blood cell transfusion of patients in study group was 52.7%, which was lower than 82.0% of patients in control group, with a statistically significant difference (χ2=18.756, P<0.001). Conclusions The apheresis autologous red blood cell transfusion could meet the needs of clinical blood transfusion in patients with THA, which is safe and effective, and could be promoted during surgery. Key words: Blood transfusion, autologous; Arthroplasty, replacement, hip; Blood component transfusion; Apheresis autologous red blood cell; Autologous blood