Study on the Morphological, Structural and Functional Changes of Erythrocytes after Washing Autotransfusion between Diabetic and Non-Diabetic Orthopedic Surgery Patients
Authors: Yao Na , Zhang Ziwei , Bai Yu , Zhou Xiaofang , Wang Jinhuo , Liu Tong , You Laiwei , Guo Jianrong 
Published: April 2022

Abstract
Objective: By observing the morphological structure and function of washing autotransfusion red blood cells in diabetic and non-diabetic patients as well as the changes of red blood cell related indicators before and after autologous blood transfusion, to explore whether intraoperative blood salvage will aggravate the diabetic red blood cell damage, and systematically evaluate the safety and effectiveness of intraoperative blood salvage for diabetic patients.Methods: 60 patients who underwent elective orthopedic surgery in our hospital from September 2019 to December 2020 were selected, aged 50 to 64 years, regardless of gender, BMI: 19-28 kg/m2, ASA classification I and II. The types of surgery include hip replacement, posterior lumbar decompression and interbody fusion, open reduction and internal fixation of femoral fractures. According to the history of diabetes, 60 patients were divided into the following two groups, group A: patients with type 2 diabetes surgery, HbA1c≥7%, group B: patients without diabetes surgery. Detection Indicator: (1) Collect central venous blood, and detect RBC count, Hb, Hct, MCV, MCH, MCHC, RDW before surgery (T1), after autologous blood collection (T3), and after surgery (T4). (2) Collect arterial blood before autologous blood collection (T2), collect autologous blood in the blood bag after autologous blood collection (T3) to compare the changes of red blood cell deformability (red blood cell morphology score under oil microscope, ELISA method to detect Na+-K+-ATPase), red blood cell oxygen release capacity (calculate P50 value, ELISA method to detect 2,3-DPG)and red blood cell apoptosis damage (use flow cytometry to detect the PS positive rate of red blood cell) before and after blood salvage.Results: Compared with before surgery, the RBC counts, Hb and Hct of the two groups of patients after autologous blood collection and after surgery were decreased; compared with after autologous blood collection, the RBC counts, Hb, Hct after surgery were increased. Compared with the blood before autologous blood collection, there was no significant differences in the red blood cell deformability; the red blood cell oxygen release capacity and the red blood cell PS positive rate of two groups were increased after autologous blood collection. Compared with non-diabetic patients, there was no significant difference in Na+-K+-ATPase activity and P50 value before autologous blood collection and after autologous blood collection in diabetic patients; Observed under the oil microscope, the red blood cells in the state of the disc with spinous process and the state of spinous process were significantly increased, and the red blood cells in the spherical state were occasionally seen. The 2,3-DPG content and the positive rate of PS were significantly increased.Conclusion: Compared with non-diabetic patients, diabetic patients' red blood cell double-concave disc-shaped morphology changes, the oxygen release capacity is still within the normal range and PS valgus is increased. The deformability of autologous red blood cells in diabetic and non-diabetic patients is not affected after intraoperative blood salvage, and the ability to release oxygen increases, but the increase in PS valgus of red blood cells increases the phagocytosis of autologous red blood cells in the body by mononuclear macrophages after reinfusion risk.