Elevated exhaled carbon monoxide concentration in hemoglobinopathies and its relation to red blood cell transfusion therapy

Department of Gastroenterology, Children's Hospital & Research Center Oakland, Oakland, California 94609, USA.
Pediatric Hematology and Oncology (Impact Factor: 1.1). 03/2010; 27(2):112-21. DOI: 10.3109/08880010903536227
Source: PubMed


In this study, the authors examined a possible role of measurements of end-tidal carbon monoxide (CO), corrected for inhaled CO (ETCOc), as a noninvasive screening tool for hemoglobinopathies and as an indicator for when transfusions would be required in patients receiving chronic transfusions. ETCOc measurements were obtained in subjects with sickle cell disease (n = 18), thalassemia (n = 21), and healthy controls (n = 62). ETCOc values less than 3 parts per million (ppm) yielded a positive predictive value of 93% and negative predictive value of 94% in identifying hemoglobinopathies. Subsequently, 7 subjects with thalassemia had laboratory parameters and ETCOc measured over 2 transfusion cycles. ETCOc values were 4.90 +/- 0.32 ppm (mean +/- SD), with 89% of values being above normal (>or=3 ppm). Pretransfusion ETCOc levels significantly correlated with pretransfusion reticulocyte count (r = .96, P <.001), but not with pretransfusion hemoglobin (r = .44, P = .16) or pretransfusion soluble transferrin receptors (sTfR, r = .52, P = .10). In conclusion, we found that patients with hemoglobinopathies have ETCOc values above the range for healthy controls and ETCOc measurements can be used as an adjunct to hemoglobin measurements to determine the proper timing of transfusions.

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    • "Through induction of HO-1, endogenous CO production could be increased by hypoxia, heavy metals, heme, exogenous CO, pro-inflammatory cytokines, hyperglycemia and hormones [36], and endogenously generated NO [20]. Thus, ECO may serve as a marker in diabetes [37], cirrhosis [38] hemoglobinopathies [39] asthma [7], cystic fibrosis [8], bronchiectasis [9], and respiratory tract infections [10]. In our study, exhaled CO levels were high in the secretory phase, reaching their highest levels in the premenstrual phase. "
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