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Clinical Chemistry 54: 594-596, 2008; 10.1373/clinchem.2007.095158
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(Clinical Chemistry. 2008;54:594-596.)
© 2008 American Association for Clinical Chemistry, Inc.

Brief Communications

A Novel Hemoglobin, Bonn, Causes Falsely Decreased Oxygen Saturation Measurements in Pulse Oximetry

Berndt Zur1,a, Andreas Hornung2, Johannes Breuer2, Ulrike Doll2, Christine Bernhardt2, Michael Ludwig1 and Birgit Stoffel-Wagner1

1 Department of Clinical Biochemistry and2 Division of Pediatric Cardiology, University of Bonn, Bonn, Germany;

aaddress correspondence to this author at: Institute for Clinical Biochemistry, University Hospital Bonn, Sigmund-Freud-Str. 25, D 53127 Bonn, Germany. Fax + 49 228 12159; e-mail berndt.zur{at}ukb.uni-bonn.de.


Abstract

Background: A 4-year-old boy and his father exhibited low oxygen saturation measured transcutaneously by pulse oximetry, a finding that could not be confirmed by arterial blood gas analysis. Both patients exhibited slight hemolysis in their blood, and the boy had a microcytic anemia. There was no evidence of hypoxemia or methemoglobinemia. Despite the normal results from the arterial blood gas analysis, a right-to-left-shunt was assumed in the boy until a cardiology examination excluded this diagnosis. Sleep apnea syndrome was suspected in the father and treated with nocturnal positive pressure respiration based on the low oxygen saturation values obtained with pulse oximetry. Only after consultation with our laboratory was a hemoglobin variant suspected and investigated.

Methods: We performed hemoglobin protein analysis by HPLC, electrophoretic separation, and spectrophotometry and DNA sequence analysis of the {alpha}-globin gene.

Results: Both HPLC chromatographic separation and alkaline electrophoresis revealed a unique hemoglobin peak. In both patients, {alpha}-globin gene sequencing revealed a mutation resulting in a histidine-to–aspartatic acid substitution at position {alpha}87. The low oxygen saturation measurement by pulse oximetry was due to hemoglobin Bonn oxyhemoglobin having an absorption peak at 668 nm, near the 660 nm measured by pulse oximeters.

Conclusion: Hemoglobin Bonn is a novel hemoglobin variant of the proximal {alpha}-globin that results in falsely low oxygen saturation measurements with pulse oximetry.






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Copyright © 2008 by the American Association for Clinical Chemistry.