Skip to main content
Download PDF

Haemoglobin Hammersmith precludes monitoring with conventional pulse oximetry

Canadian Journal of Anaesthesia volume 41, pages 965–968 (1994)Cite this article

Abstract

We report a case of a 15-yr-old North American Indian female with haemoglobin Hammersmith, scheduled for elective tonsillectomy, whose arterial oxygen saturation could not be reliably monitored perioperatively because of technical limitations of conventional dual wavelength pulse oximetry. The patient was chronically icteric. She had an atrial septal defect with a small L → R shunt demonstrated by echocardiography. On arrival in the operating room pulse oximetry (Nellcor-Model N100) demonstrated a saturation of 45% whilst breathing room air. Her oxygen saturation increased to 60% whilst breathing 100% oxygen via a face mask. An arterial blood gas performed whilst breathing 100% oxygen revealed a PaO2 of 418 mmHg. Tonsillectomy was completed uneventfully under general anaesthesia. The pulse oximeter did not provide any clinically useful information throughout the case. In conclusion, conventional dual wavelength puke oximeters cannot give an accurate estimate of oxygenation in patients with haemoglobin Hammersmith. Assessment of oxygenation in these patients requires alternative monitoring techniques.

Résumé

Nous rapportons le cas d’une autochtone nord-américaine de 15 ans, porteuse d’hémoglobine Hammersmith, programmée pour une amygdalectomie et dont la saturation en oxygène ne peut être mesurée avec fiabilité à cause des limitations de la technique habituelle de l’oxymétrie puisée à deux longueurs d’ondes. La patiente est une ictérique chronique. L’échographie a révélé une communication interauriculaire avec un léger shunt d-g. A sont arrivée en salle d’opération, l’oxymétre (Nellcor-Model N100) affiche une saturation à 45% en air. La saturation sous oxygène à 100% par masque facial augmente à 60%. Un gaz artériel réalisé sous oxygène à 100% montre une PaO2 de 418 mmHg. L’amygdalectomie est complétée sans incident sous anesthésie générale. L’oxymétrie puisée ne procure pas d’autres renseignements cliniques pertinents. Pour conclure, l’oxymétrie puisée à double longueur d’ondes ne peut évaluer avec précision l’oxygénation en présence d’hémoglobine d’Hammersmith. L’évaluation de l’oxygénation dans ces cas nécessite des techniques de monitorage différentes.

References

  1. Carver MFH, Huisman THJ. Policies of the International Hemoglobin Information Center. Hemoglobin 1993; 17: 89–177.

    Article  Google Scholar 

  2. Liebhaber SA, Manno CS. Update on hemoglobinopathies. Disease-a-Month 1983; 28: 1–74.

    Google Scholar 

  3. Roizen MR. Anesthetic implications of concurrent diseases.In: Miller RD (Ed.). Anesthesia, 3rd ed. New York: Churchill Livingstone, 1990; 860–3.

    Google Scholar 

  4. Shinton NK, Thursby-Pelham DC, Williams HP. Congenital Heinz-body haemolytic anaemia due to Haemoglobin Hammersmith. Postgrad Med J 1969; 45: 629–32.

    PubMed  CAS  Google Scholar 

  5. May A, Huehns ER. The oxygen affinity of Haemoglobin Hammersmith. Br J Haematol 1975; 30: 185–95.

    PubMed  Article  CAS  Google Scholar 

  6. Cunningham TA, Baker F, Kobrinsky NL, et al. The unstable Hb Hammersmith or α2β2 42(CDI)Phe→Ser observed in an Indian child; identification by HPLC and by sequence analysis of amplified DNA. Hemoglobin 1992; 16: 19–25.

    PubMed  Article  CAS  Google Scholar 

  7. Tremper KK, Barker SJ. Pulse oximetry. Anesthesiology 1989; 70: 98–108.

    PubMed  CAS  Google Scholar 

  8. Mendelson Y. Pulse oximetry: theory and applications for noninvasive monitoring. Clin Chem 1992; 38: 1601–7.

    PubMed  CAS  Google Scholar 

  9. Tremper KK, Barker SJ. Pulse oximetry. Anesthesiology 1989; 70: 98–108.

    PubMed  CAS  Google Scholar 

  10. Mahoney JJ, Vreman HJ, Stevenson DK, Van Kessel AL. Measurement of carboxyhemoglobin and total hemoglobin by five specialized spectrophotometers (CO-oximeters) in comparison with Reference Methods. Clin Chem 1993; 39: 1693–700.

    PubMed  CAS  Google Scholar 

  11. Severinghaus JW, Kelleher JF. Recent developments in pulse oximetry. Anesthesiology 1992; 76: 1018–38.

    PubMed  CAS  Article  Google Scholar 

  12. Ralston AC, Webb RK, Runciman WB. Potential errors in pulse oximetry. III: Effects of interference, dyes, dyshaemoglobins and other pigments. Anaesthesia 1991; 46: 291–5.

    PubMed  Article  CAS  Google Scholar 

  13. Chisholm DG, Stuart H. Congenital methaemoglobinaemia detected by preoperative pulse oximetry. Can J Anaesth 1994; 41: 519–22.

    PubMed  CAS  Article  Google Scholar 

  14. Katoh R, Miyake T, Aral T. Unexpectedly low pulse oximeter readings in a boy with unstable hemoglobin Köln. Anesthesiology 1994; 80: 472–4.

    PubMed  Article  CAS  Google Scholar 

  15. Gottschalk A, Silverberg M. An unexpected finding with pulse oximetry in a patient with hemoglobin Köln. Anesthesiology 1994; 80: 474–6.

    PubMed  Article  CAS  Google Scholar 

  16. Tremper KK, Barker SJ. Monitoring of oxygen.In: Lake CL (Ed.). Clinical Monitoring. Philadelphia: WB Saunders Co., 1990; 283–313.

    Google Scholar 

Download references

Author information

Affiliations

  1. Department of Anaesthesia, Royal University Hospital, S7N 0X0, Saskatoon, Saskatchewan, Canada

    Scott A. Lang, Paul C. Chang & Victor A. Laxdal

  2. Department of Pathology, Royal University Hospital, S7N0X0, Saskatoon, Saskatchewan, Canada

    Scott A. Lang, Paul C. Chang & Victor A. Laxdal

  3. Department of Biochemistry and Molecular Biology, Medical College of Georgia, 30912-2100, Augusta, GA, USA

    Titus H. J. Huisman

Authors
  1. Scott A. Lang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Paul C. Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Victor A. Laxdal
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Titus H. J. Huisman
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Lang, S.A., Chang, P.C., Laxdal, V.A. et al. Haemoglobin Hammersmith precludes monitoring with conventional pulse oximetry. Can J Anaesth 41, 965–968 (1994). https://doi.org/10.1007/BF03010939

Download citation

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03010939

Key words

  • blood: haemoglobin Hammersmith
  • measurement techniques: oximeters, pulse
  • monitoring: oxygen