Low pulse oximeter‐measured hemoglobin oxygen saturations with hemoglobin Cheverly

• Published in: American journal of hematology 1998-11, Vol.59 (3), p.181-184
• Main Authors: Hohl, Raymond J., Sherburne, Alan R., Feeley, James E., Huisman, Titus H. J., Burns, C. Patrick
• Format: Article
• Language: English
• Subjects: Adult; Anemias. Hemoglobinopathies; Biological and medical sciences; Blood Gas Analysis; co‐oximetry; Diseases of red blood cells; Female; Hematologic and hematopoietic diseases; hemoglobin Cheverly; Hemoglobins, Abnormal - chemistry; Hemoglobins, Abnormal - physiology; Humans; Medical sciences; Oximetry; oxygen saturation; Oxyhemoglobins - analysis; pulse oximeter
• ISSN: 0361-8609; 1096-8652
• DOI: 10.1002/(SICI)1096-8652(199811)59:3<181::AID-AJH1>3.0.CO;2-I

Unexpectedly low hemoglobin oxygen saturation as determined by pulse‐oximeter analysis was observed in a patient who underwent an elective surgical procedure. Specific hemoglobin derivatives such as carboxyhemoglobin, methemoglobin, and reduced hemoglobin that have been described to lower pulse‐oximetry determination of oxygenation were not detected. Absorbance spectra revealed the patient's hemoglobin to be different than that obtained from two normal volunteers. High‐pressure liquid chromatographic analysis of the hemoglobin showed an unknown band that comprised 15% of the patient's hemoglobin. DNA sequence analysis showed a point mutation in the second nucleotide of the 45th codon of the β‐globin chain. This mutation encodes for an abnormal β‐chain (β‐45 Phe→Ser) that has been described as hemoglobin Cheverly. Hemoglobin Cheverly is an unstable hemoglobin that has a similar mutation as the β‐42 Phe→Ser mutation seen in hemoglobin Hammersmith. Hemoglobin Hammersmith and another unstable hemoglobin, hemoglobin Köln, have previously been described to have unexpectedly low pulse‐oximeter–determined oxyhemoglobin levels. That we find hemoglobin Cheverly to result in a similar phenomenon suggests that pulse‐oximeter monitoring of oxygenation status may not be appropriate for the unstable hemoglobins. Low pulse‐oximeter oxygenation determinations for these hemoglobins do not appear to predict clinical hypoxemia. Am. J. Hematol. 59:181–184, 1998. © 1998 Wiley‐Liss, Inc.