Schiemsky Toon, Penders Joris, Kieffer Davy
a Laboratory Medicine , University Hospitals Leuven , Leuven , Belgium.
b School of Life Sciences , Biomedical Research Institute, Hasselt University and Transnational University Limburg , Diepenbeek , Belgium.
Acta Clin Belg. 2016 Jun;71(3):167-70. doi: 10.1080/17843286.2016.1148299. Epub 2016 Apr 21.
We present a case of an arterial blood gas sample analysis from a 33-year old woman where no oximetry results could be obtained using the Radiometer ABL800 FLEX device. Clinical history of this patient learned that she was carrier of a methemoglobin forming hemoglobin variant type Hyde Park (HbM Hyde Park) and raised the question whether or not this variant could be the cause of the errors obtained during analysis.
A literature search was performed, focusing on methemoglobin forming hemoglobin variants and their influence on oxygenation measurements. An overview of the currently described methemoglobin forming hemoglobin variants is also included.
In the presence of dyshemoglobins such as methemoglobin, techniques used to obtain parameters that reflect the patient oxygenation status, such as pulse oximetry and CO-oximetry can be influenced. In these cases, CO-oximetry is the preferred technique because it can compensate for this, in contrast to pulse oximetry. In case of the presence of methemoglobin originating from a hemoglobin variant, it is possible that CO-oximetry data cannot be calculated because the absorbance spectrum of this methemoglobin can differ from regular methemoglobin. Moreover, pulse oximetry devices are actually prone to erroneous results since pulse oximetry data will be calculated in these cases, but unreliable and should be avoided.
Methemoglobin forming hemoglobin variants are rare genetic mutations. However, they can possibly interfere with the calculation of CO-oximetry values. In these cases, pulse oximetry data should be avoided because they could lead to incorrect medical decisions.
我们报告一例33岁女性的动脉血气样本分析病例，使用Radiometer ABL800 FLEX设备无法获得血氧饱和度测量结果。从该患者的临床病史了解到，她是形成高铁血红蛋白的海德公园型血红蛋白变体（HbM海德公园）的携带者，这就提出了一个问题，即这种变体是否可能是分析过程中出现误差的原因。
进行了文献检索，重点关注形成高铁血红蛋白的血红蛋白变体及其对氧合测量的影响。还包括了目前已描述的形成高铁血红蛋白的血红蛋白变体的概述。
在存在高铁血红蛋白等异常血红蛋白的情况下，用于获取反映患者氧合状态参数的技术，如脉搏血氧饱和度测定法和血气多参数测定法可能会受到影响。在这些情况下，血气多参数测定法是首选技术，因为与脉搏血氧饱和度测定法不同，它可以对此进行补偿。如果存在源自血红蛋白变体的高铁血红蛋白，可能无法计算出血气多参数测定法数据，因为这种高铁血红蛋白的吸收光谱可能与正常高铁血红蛋白不同。此外，脉搏血氧饱和度测定设备实际上容易出现错误结果，因为在这些情况下会计算脉搏血氧饱和度测定数据，但不可靠，应避免使用。
形成高铁血红蛋白的血红蛋白变体是罕见的基因突变。然而，它们可能会干扰血气多参数测定法值的计算。在这些情况下，应避免使用脉搏血氧饱和度测定数据，因为它们可能导致错误的医疗决策。
