Document Detail


Unexpectedly low pulse oximetry measurements associated with variant hemoglobins: a systematic review.
MedLine Citation:
PMID:  20890907     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Pulse oximetry estimates arterial blood oxygen saturation based on light absorbance of oxy- and deoxy-hemoglobin at 660 and 940 nm wavelengths. Patients with unexpectedly low SpO₂ often undergo cardio-pulmonary testing to ascertain the cause of their hypoxemia. However, in a subset of patients, a variant hemoglobin is responsible for low SpO₂ measurements. The extent of this problem is unclear. We performed a systematic literature review for reports of low SpO₂ associated with variant hemoglobins. We also reviewed unpublished cases from an academic hemoglobin diagnostic reference laboratory. Twenty-five publications and four unpublished cases were identified, representing 45 patients with low SpO₂ and confirmed variant hemoglobin. Fifty-seven family members of patients had confirmed or suspected variant hemoglobin. Three low oxygen affinity variant hemoglobins had concordantly low SpO₂ and SaO₂. Eleven variant hemoglobins were associated with unexpectedly low SpO₂ measurements but normal SaO₂. Hemoglobin light absorbance testing was reported in three cases, all of which showed abnormal absorption spectra between 600 and 900 nm. Seven other variant hemoglobins had decreased SpO₂, with unreported or uncertain SaO₂. Twenty-one variant hemoglobins were found to be associated with low SpO₂. Most variant hemoglobins were associated with spuriously low SpO₂. Abnormal absorption spectra explain the discrepancy between SpO₂ and SaO(2) for some variants. The differential diagnosis of possible variant hemoglobin ought to be considered in asymptomatic patients found to have unexpectedly low SpO₂. The correct diagnosis will help to spare patients from unnecessary investigations and anxiety.
Authors:
Madeleine Verhovsek; Matthew P A Henderson; Gerard Cox; Hong-yuan Luo; Martin H Steinberg; David H K Chui
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Review    
Journal Detail:
Title:  American journal of hematology     Volume:  85     ISSN:  1096-8652     ISO Abbreviation:  Am. J. Hematol.     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-10-26     Completed Date:  2010-12-10     Revised Date:  2011-09-01    
Medline Journal Info:
Nlm Unique ID:  7610369     Medline TA:  Am J Hematol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  882-5     Citation Subset:  IM    
Copyright Information:
© 2010 Wiley-Liss, Inc.
Affiliation:
Section of Hematology and Oncology, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA. verhovm@mcmaster.ca
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MeSH Terms
Descriptor/Qualifier:
Diagnosis, Differential
Genetic Variation*
Hemoglobinopathies / diagnosis
Hemoglobins / genetics*,  physiology
Humans
Oximetry / statistics & numerical data*
Grant Support
ID/Acronym/Agency:
R01 DK63088/DK/NIDDK NIH HHS; RR-08084/RR/NCRR NIH HHS; U54 HL070871/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Hemoglobins
Comments/Corrections
Corrected and Republished In:
Am J Hematol. 2011 Aug;86(8):722-5   [PMID:  21879495 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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