Carbon monoxide production in patients with breast carcinoma.

Total haem catabolism has been studied through measurement of endogenous production of carbon monoxide (VCO) in 19 patients treated for breast carcinoma. The subjects were divided into three groups. Group A included six patients with haemoglobin (Hb) concentration greater than 11.5 g/dl and considered free from disease. Group B consisted of seven patients with distant metastases and Hb concentration greater than 11.5 g/dl and group C of six patients with distant metastases and anaemia (Hb concentration less than 11.5 g/dl). VCO in group A was 10.3 +/- 3.7 (mean +/- 1 SD) and in group B 9.0 +/- 2.5 mumol/mmol total body haem (TBH)/d. These values are not different from our normal values of 10.8 +/- 2.8 mumol/mmol TBH/d. In group C VCO was 21.1 +/- 3.1 (an increase of 100%). VCO was compared to daily catabolism of circulating red cell haemoglobin haem (Vhaem-c) in the VCO/Vhaem-c quotient. Vhaem-c was calculated from total circulating red cell haemoglobin haem (TBHb-c) and red cell survival. In group A and group B this quotient was 1.3 +/- 0.6 and 1.1 +/- 0.2, respectively, and in group C was 2.5 +/- 0.9. The difference between group A and B on one side and group C on the other side was significant (P less than 0.001). The 'extra' CO produced in patients with anaemia and disseminated disease (group C) was thought to originate from increased turnover of bone marrow haem, reflecting considerable ineffective erythropoiesis with destruction of haemoglobinized immature red cells. The results confirm earlier findings of a high VCO/Vhaem-c quotients in patients with anaemia secondary to Hodgkin's disease.