Alotaibi Atheer T, Alhowaish Abdullah A, Alshahrani Abdullah, Alfaraj Dunya
Medicine Department, Imam Abdulrahman Bin Faisal University, Dammam, SAU.
Emergency Department, Imam Abdulrahman Bin Faisal University, Dammam, SAU.
Cureus. 2021 Mar 24;13(3):e14079. doi: 10.7759/cureus.14079.
Methemoglobinemia is a blood disorder in which there is an elevated level of methemoglobin. In contrast to normal hemoglobin, methemoglobin does not bind to oxygen, which leads to functional anemia. The signs of methemoglobinemia often overlap with other cardiovascular and pulmonary diseases, with cyanosis being the key sign of methemoglobinemia. Emergency physicians may find it challenging to diagnose cyanosis as a result of methemoglobinemia. Our patient is a healthy 28-year-old male, a heavy smoker, who presented to the emergency department with multiple minimum bruises on his body, claiming he was assaulted at work. He appeared cyanotic with an O saturation of 82% (normal range is 95-100%) in room air. He also mentioned that his sister complained of a similar presentation of cyanosis but was asymptomatic. All these crucial points strengthened the idea that methemoglobinemia was congenital in this patient. The case was challenging to the emergency physician, and there was significant controversy over whether the patient's hypoxia was a result of the trauma or congenital methemoglobinemia.
高铁血红蛋白血症是一种血液疾病，其中高铁血红蛋白水平升高。与正常血红蛋白不同，高铁血红蛋白不与氧气结合，这会导致功能性贫血。高铁血红蛋白血症的体征常与其他心血管和肺部疾病重叠，发绀是高铁血红蛋白血症的关键体征。由于高铁血红蛋白血症导致的发绀，急诊医生可能会发现诊断具有挑战性。我们的患者是一名28岁健康男性，重度吸烟者，因身上有多处轻微瘀伤而就诊于急诊科，称自己在工作时遭到袭击。他在室内空气中呈现发绀，血氧饱和度为82%（正常范围为95 - 100%）。他还提到他的妹妹也有类似的发绀表现但无症状。所有这些关键点都强化了该患者高铁血红蛋白血症为先天性的观点。该病例对急诊医生来说具有挑战性，并且对于患者的缺氧是由创伤还是先天性高铁血红蛋白血症导致存在重大争议。
