[Chinese expert consensus on the diagnosis and treatment of high-altitude polycythemia(2025)].

Abstract

High-altitude polycythemia (HAPC) is defined as a secondary excessive erythrocytosis caused by prolonged exposure to hypoxic environments at altitudes above 2,500 meters, characterized primarily by significantly elevated hemoglobin levels (≥210 g/L in males and ≥190 g/L in females). Clinically, HAPC manifests as headache, fatigue, sleep disturbances, and is prone to complications such as thrombosis and organ damages. China encompasses extensive high-altitude regions of critical strategic significance, with a growing population of residents and travelers relocating or temporarily staying in these areas. However, there has been a lack of systematic and standardized clinical guidelines for the diagnosis and management of high-altitude-related diseases. To standardize the diagnosis and treatment of HAPC in China, the Red Blood Cell Disease Group, Chinese Society of Hematology, Chinese Medical Association and Chinese Hospital Association Hematology Branch formulated this consensus based on extensive expert consultation, integrating the latest evidence-based findings and practical experience in high-altitude medicine. The consensus defines a stratified diagnostic and therapeutic strategy to guide the clinical management of HAPC: mild cases are managed with low-flow oxygen therapy; moderate cases require combined pharmacological and oxygen therapy; and severe cases are recommended for erythrocytapheresis as the primary intervention, supplemented by pharmacotherapy and oxygen support.