Alterations in 2-3 Diphosphoglycerate and O ₂ Hemoglobin Affinity in Patients Undergoing Open-Heart Surgery

Abstract

Alterations in red blood cell (RBC) 2-3 diphosphoglycerate (2-3 DPG) and hemoglobin affinity for oxygen were studied in 14 patients undergoing heart-lung bypass. RBC 2-3 DPG decreased with institution of bypass and continued to decrease during bypass. The day following heart-lung bypass RBC 2-3 DPG levels returned to normal, but were lower than preoperative control values. In vitro studies demonstrated that a portion of the RBC 2-3 DPG loss is due to circulation of blood through the oxygenator itself. Other factors appear to be involved. Hemoglobin affinity for oxygen increased during heart-lung bypass in most patients It was found that the increased affinity was less than would be expected relative to the demonstrated RBC 2-3 DPG decrease, and that a progressive decrease in RBC pH partially corrected the alteration in O 2 affinity. Our data suggest that other factors are involved in the demonstrated alteration in hemoglobin affinity for O 2 , and these factors are discussed.

Oxygen carrying capacity of salvaged blood in patients undergoing off-pump coronary artery bypass grafting surgery: a prospective observational study

“…But, cardiopulmonary bypass (CPB) was routinely used in their study and allogeneic RBCs were transfused in 6 patients. CPB can decrease 2, 3-DPG content of RBCs and in our study, the 2, 3-DPG level in 2-week-old packed RBCs had dropped to 2.62 ± 3.13 μmol/g Hb (0.0 in 6 patients) [ 28 , 29 ]. So, the use of CPB and allogeneic RBCs may influence the accuracy of their results and was excluded in our study.…”

The influence of position on ventilation‐perfusion distribution after abdominal surgery

“…Since the P50 value was not measured in this study but only estimated, this could lead to an overestimation of Pa02 established from the inert gas data. Indeed, red cells 2-3 DPG levels are altered in several clinical conditions, including large blood transfusion (29). Furthermore, Dueck et al suggested that some variability in the breathing pattern during spontaneous ventilation could explain why measured Pa02 are slightly greater than predicted Pa02 in their study (30).…”

“…Indeed, red cells 2-3 DPG levels are altered in several clinical conditions, including large blood transfusion (29). Since the P50 value was not measured in this study but only estimated, this could lead to an overestimation of Pa02 established from the inert gas data.…”

Respiratory Characteristics of Blood following the Interatrial Baffle Procedure for Dextro Transposition of the Great Arteries

“…Furthermore, the fall in P50 did not occur in the two children who received no blood in the postoperative period, but had the same pump prime and bypass conditions. It should be noted, however, that studies by Bordiuk et al (2) have shown that open heart surgery and carciopulmonary bypass can be associated with decreases of 2,3-DPG and P50, perhaps due to the fall of pH within the red cell during bypass.…”