用碳氧血红蛋白和高铁血红蛋白水平诊断接受机械循环支持装置治疗患者的溶血情况。

Carboxyhemoglobin and methemoglobin levels to diagnose hemolysis in patients supported with mechanical circulatory support devices.

作者信息

Rodgers Ingrid L, Yip Daniel S, Patel Parag C, Keller Cesar A

机构信息

Anesthesiology, Mayo Clinic Florida, Jacksonville, Florida.

Transplant Department, Mayo Clinic Florida, Jacksonville, Florida.

出版信息

JHLT Open. 2023 Nov 19;3:100025. doi: 10.1016/j.jhlto.2023.100025. eCollection 2024 Feb.

DOI:10.1016/j.jhlto.2023.100025

PMID:40145116

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11935344/

Abstract

BACKGROUND

Decreased systemic oxygen delivery derived from gas exchange abnormalities in severe hemolysis complicates patients requiring mechanical circulatory support devices. Severe hemolysis releases free hemoglobin in plasma causing elevation of carboxyhemoglobin and methemoglobin levels. Hemolysis-induced decline in hemoglobin and oxyhemoglobin saturation significantly reduces the arterial oxygen content in blood, reducing systemic oxygen delivery. These patients develop hypoxemia with misleadingly normal oxygen saturation measured by standard pulse oximetry.

METHODS

Retrospective review of 2 clinical cases reaching carboxyhemoglobin and methemoglobin levels > 2% while supported with an Impella device.

RESULTS

Case 1. Patient with cardiogenic shock refractory to maximal medical therapy required insertion of Impella device achieving improvement in cardiac output, pulse oximetry, arterial oxygen saturation and systemic oxygen delivery. The device caused significant hemolytic anemia with severe decline in hemoglobin and arterial oxygen saturation with elevation of carboxyhemoglobin and methemoglobin levels, causing drastic reduction in systemic oxygen delivery despite adequate cardiac output. Device removal reversed severe hemolytic anemia, causing increased arterial oxygen saturation and systemic oxygen delivery despite borderline cardiac output.Case 2. Patient with refractory cardiogenic shock improved after insertion of Impella device. Initial improvement cardiac output and systemic oxygen delivery was negated by hemolytic anemia associated with elevation of carboxyhemoglobin and methemoglobin levels. Hemolysis decreased by reducing the Impella power output. Carboxyhemoglobin and methemoglobin levels correlated precisely with degree of hemolysis allowing to titrate therapy to best systemic oxygen delivery.

CONCLUSIONS

Monitoring carboxyhemoglobin and methemoglobin levels readily identifies patients with ongoing hemolysis secondary to invasive supportive devices.

摘要

背景

严重溶血导致气体交换异常，进而引起全身氧输送减少，这使需要机械循环支持装置的患者病情复杂化。严重溶血会使血浆中释放游离血红蛋白，导致碳氧血红蛋白和高铁血红蛋白水平升高。溶血导致血红蛋白和氧合血红蛋白饱和度下降，显著降低血液中的动脉血氧含量，从而减少全身氧输送。这些患者会出现低氧血症，而通过标准脉搏血氧饱和度测定法测得的氧饱和度却正常，具有误导性。

方法

回顾性分析2例在使用Impella装置支持期间碳氧血红蛋白和高铁血红蛋白水平>2%的临床病例。

结果

病例1。一名对最大程度药物治疗无效的心源性休克患者需要插入Impella装置，以改善心输出量、脉搏血氧饱和度、动脉血氧饱和度和全身氧输送。该装置导致严重溶血性贫血，血红蛋白和动脉血氧饱和度严重下降，同时碳氧血红蛋白和高铁血红蛋白水平升高，尽管心输出量充足，但全身氧输送仍大幅降低。移除装置后，严重溶血性贫血得到逆转，尽管心输出量处于临界水平，但动脉血氧饱和度和全身氧输送增加。病例2。一名难治性心源性休克患者在插入Impella装置后病情有所改善。最初的心输出量和全身氧输送改善被与碳氧血红蛋白和高铁血红蛋白水平升高相关的溶血性贫血所抵消。通过降低Impella的功率输出，溶血有所减轻。碳氧血红蛋白和高铁血红蛋白水平与溶血程度精确相关，这使得能够根据最佳全身氧输送来调整治疗方案。