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The carbon monoxide re-breathing method can underestimate Hbmass due to incomplete blood mixing

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Abstract

Purpose

Hemoglobin mass (Hbmass) is commonly assessed using the CO re-breathing method with the subject in the seated position. This may lead to an underestimation of Hbmass as blood in lower extremity veins while seated may not be tagged with carbon monoxide (CO) during the re-breathing period.

Methods

To test this hypothesis, CO re-breathing was performed on four occasions in nine male subjects, twice in the seated position and twice in combination with light cycle ergometer exercise (1 W/kg body-weight) intending to accelerate blood circulation and thereby potentially allowing for a better distribution of CO throughout the circulation as compared to in the seated position. Blood samples were drawn from an antecubital vein and the saphenous magna vein following the re-breathing procedure.

Results

In the seated position, CO re-breathing increased the percent carboxyhemoglobin (%HbCO) in the antecubital vein to 8.9 % (7.8–10.7) [median (min–max)], but less (P = 0.017) in the saphenous magna vein [7.8 % (5.0–9.9)]. With exercise, no differences in %HbCO were observed between sampling sites. As a result, CO re-breathing in combination with exercise revealed a ~3 % higher (P = 0.008) Hbmass, i.e., 936 g (757–1,018) as compared to 908 g (718–940) at seated rest.

Conclusion

This study suggests an uneven distribution of CO in the circulation if the CO re-breathing procedure is performed at rest in the seated position and therefore can underestimate Hbmass.

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References

  • Ashenden MJ, Gore CJ, Burge CM, Clough ML, Bourdon PC, Dobson GP, Hahn AG (1999) Skin-prick blood samples are reliable for estimating Hb mass with the CO-dilution technique. Eur J Appl Physiol 79:535–537

    Article  CAS  Google Scholar 

  • Blackmore DJ (1970) Distribution of HbCO in human erythrocytes following inhalation of CO. Nature 227:386

    Article  PubMed  CAS  Google Scholar 

  • Bruce MC, Bruce EN (2006) Analysis of factors that influence rates of carbon monoxide uptake, distribution, and washout from blood and extravascular tissues using a multi compartment model. J Appl Physiol 100:1171–1180

    Article  PubMed  CAS  Google Scholar 

  • Burge CM, Skinner SL (1995) Determination of hemoglobin mass and blood volume with CO: evaluation and application of a method. J Appl Physiol 79:623–631

    PubMed  CAS  Google Scholar 

  • Flamm SD, Taki J, Moore R, Lewis SF, Keech F, Maltais F, Ahmad M, Callahan R, Dragotakes S, Alpert N (1990) Redistribution of regional and organ blood volume and effect on cardiac function in relation to upright exercise intensity in healthy human subjects. Circulation 81:1550–1559

    Article  PubMed  CAS  Google Scholar 

  • Froelich JW, Strauss HW, Moore RH, McKusick KA (1988) Redistribution of visceral blood volume in upright exercise in healthy volunteers. J Nucl Med 29:1714–1718

    PubMed  CAS  Google Scholar 

  • Garvican LA, Burge CM, Cox AJ, Clark SA, Martin DT, Gore CJ (2010) Carbon monoxide uptake kinetics of arterial, venous and capillary blood during CO rebreathing. Exp Physiol 95:1156–1166

    Article  PubMed  CAS  Google Scholar 

  • Gore CJ, Hopkins WG, Burge CM (2005) Errors of measurement for blood volume parameters: a meta-analysis. J Appl Physiol 99:1745–1758

    Article  PubMed  Google Scholar 

  • Gough CE, Eastwood A, Saunders PU, Anson JM, Gore CJ (2012) Spurious Hb mass increases following exercise. Int J Sports Med 33:691–695

    Article  PubMed  CAS  Google Scholar 

  • Hopkins WG (2000) Measures of reliability in sports medicine and science. Sports Med 30:1–15

    Article  PubMed  CAS  Google Scholar 

  • Hutler M, Beneke R, Boning D (2000) Determination of circulating hemoglobin mass and related quantities by using capillary blood. Med Sci Sports Exerc 32:1024–1027

    PubMed  CAS  Google Scholar 

  • International Committee for Standardization in Haematology (1980) Recommended methods for measurement of red-cell and plasma volume. J Nucl Med 21:793–800

    Google Scholar 

  • Laub M, Hvid-Jacobsen K, Hovind P, Kanstrup IL, Christensen NJ, Nielsen SL (1993) Spleen emptying and venous hematocrit in humans during exercise. J Appl Physiol 74:1024–1026

    PubMed  CAS  Google Scholar 

  • Lundby C, Thomsen JJ, Boushel R, Koskolou M, Warberg J, Calbet JA, Robach P (2007) Erythropoietin treatment elevates haemoglobin concentration by increasing red cell volume and depressing plasma volume. J Physiol 578:309–314

    Article  PubMed  CAS  Google Scholar 

  • Morkeberg J, Sharpe K, Belhage B, Damsgaard R, Schmidt W, Prommer N, Gore CJ, Ashenden MJ (2011) Detecting autologous blood transfusions: a comparison of three passport approaches and four blood markers. Scand J Med Sci Sports 21:235–243

    Article  PubMed  CAS  Google Scholar 

  • Prommer N, Schmidt W (2007) Loss of CO from the intravascular bed and its impact on the optimised CO-rebreathing method. Eur J Appl Physiol 100:383–391

    Article  PubMed  Google Scholar 

  • Prommer N, Sottas PE, Schoch C, Schumacher YO, Schmidt W (2008) Total hemoglobin mass: a new parameter to detect blood doping? Med Sci Sports Exerc 40:2112–2118

    Article  PubMed  CAS  Google Scholar 

  • Robach P, Schmitt L, Brugniaux JV, Nicolet G, Duvallet A, Fouillot JP, Moutereau S, Lasne F, Pialoux V, Olsen NV, Richalet JP (2006) Living high-training low: effect on erythropoiesis and maximal aerobic performance in elite Nordic skiers. Eur J Appl Physiol 97:695–705

    Article  PubMed  Google Scholar 

  • Robach P, Boisson RC, Vincent L, Lundby C, Moutereau S, Gergelé L, Michel N, Duthil E, Féasson L, Millet GY (2012) Hemolysis induced by an extreme mountain ultra-marathon is not associated with a decrease in total red blood cell volume. Scand J Med Sci Sports: n/a–n/a

  • Sandler MP, Kronenberg MW, Forman MB, Wolfe OH, Clanton JA, Partain CL (1984) Dynamic fluctuations in blood and spleen radioactivity: splenic contraction and relation to clinical radionuclide volume calculations. J Am Coll Cardiol 3:1205–1211

    Article  PubMed  CAS  Google Scholar 

  • Schmidt W, Prommer N (2005) The optimised CO-rebreathing method: a new tool to determine total haemoglobin mass routinely. Eur J Appl Physiol 95:486–495

    Article  PubMed  CAS  Google Scholar 

  • Steiner T, Wehrlin JP (2011) Does hemoglobin mass increase from age 16 to 21 and 28 in elite endurance athletes? Med Sci Sports Exerc 43:1735–1743

    Article  PubMed  CAS  Google Scholar 

  • Stewart IB, McKenzie DC (2002) The human spleen during physiological stress. Sports Med 32:361–369

    Article  PubMed  Google Scholar 

  • Thomsen JK, Fogh-Andersen N, Bulow K, Devantier A (1991) Blood and plasma volumes determined by carbon monoxide gas, 99mTc-labelled erythrocytes, 125I-albumin and the T 1824 technique. Scand J Clin Lab Invest 51:185–190

    Article  PubMed  CAS  Google Scholar 

  • Ulrich G, Bartsch P, Friedmann-Bette B (2011) Total haemoglobin mass and red blood cell profile in endurance-trained and non-endurance-trained adolescent athletes. Eur J Appl Physiol 111:2855–2864

    Article  PubMed  CAS  Google Scholar 

  • Wennesland R, Brown E, Hopper J Jr, Scott KG, Hodges JL Jr, Bradley B (1962) Experiences with the radiochromium method for determination of red cell volume. Scand J Clin Lab Invest 14:355–367

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Zurich Center of Integrative Human Physiology, Institute of Physiology, University of Zürich, Winterthurerstrasse 190, 8057, Zurich, Switzerland

    Stefanie Keiser, Christoph Siebenmann, Thomas Christian Bonne, Henrik Sørensen & Carsten Lundby

  2. Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland

    Stefanie Keiser

  3. Département Médical, ENSA, Ecole Nationale des Sports de Montagne, Chamonix, France

    Paul Robach

Authors
  1. Stefanie Keiser
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  2. Christoph Siebenmann
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  3. Thomas Christian Bonne
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  4. Henrik Sørensen
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  5. Paul Robach
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  6. Carsten Lundby
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Corresponding author

Correspondence to Carsten Lundby.

Additional information

Communicated by Peter Krustrup.

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Keiser, S., Siebenmann, C., Bonne, T.C. et al. The carbon monoxide re-breathing method can underestimate Hbmass due to incomplete blood mixing. Eur J Appl Physiol 113, 2425–2430 (2013). https://doi.org/10.1007/s00421-013-2681-0

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  • DOI: https://doi.org/10.1007/s00421-013-2681-0

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