Carboxyhemoglobinemia in a pediatric cardiopulmonary bypass patient derived from a contaminated unit of allogenic blood

Abstract

A 4.3 kg, three-month-old patient, diagnosed with a perimembranous ventricular septal defect, presented for cardiac surgery. Upon initiation of cardiopulmonary bypass (CPB), the patient developed carboxyhemoglobinemia (11.1%). Potential sources for the unexpected acquired carboxyhemoglobinemia were sought quickly. Testing of residual blood from the unit of packed red blood cells (PRBCs) used to prime the CPB circuit revealed a carboxyhemoglobin (COHb) of 15.1 %. A decrease in cerebral oximetry (rSO(2)) on CPB was initially felt to be a result of the elevated COHb levels. When ventilation of the oxygenator with 100% oxygen (O(2)) failed to decrease COHb levels, a partial exchange transfusion was performed with reduction in COHb to 7.1%. The operation was completed successfully and the patient's COHb levels returned to normal within 75 minutes. Post case analysis of events and data collected during the case revealed a broader differential for explaining the compromised patient's O(2) delivery than the transient acquired carboxyhemoglobinemia. A partial obstruction of the superior vena cava could have triggered the drop in rSO(2) on CPB. Follow-up of the donor blood confirmed the donor had previously undiagnosed carboxyhemoglobinemia as a result of chronic carbon monoxide exposure from a faulty vehicle exhaust system.

Toxic elements in packed red blood cells from smoker donors: a risk for paediatric transfusion?

“…In the present study, the mean of COHb concentration was 14 times higher in the PRBCs from smokers compared with non‐smokers. These data corroborate previous findings from our group and from other studies, indicating that COHb levels are higher in PRBCs from smoker donors . It is worrisome that there are currently no guidelines reporting a safe limit for COHb levels in transfusion .…”

“…Elevated COHb levels in these PRBCs are caused by the higher affinity of haemoglobin for carbon monoxide (CO), a cigarette smoke constituent, than oxygen (O 2 ) . COHb is unable to transport O 2 , increasing the risk of poor oxygen deliver to organs with an elevated metabolic rate, such as the heart and brain . Thus, PRBCs with elevated COHb levels could be ineffective or dangerous if transfused to a debilitated elderly recipient or a neonate .…”

Improvement of Olfactory Function With High Frequency Non-invasive Auricular Electrostimulation in Healthy Humans

“…This allows accurate measurement of site-specific tissue oxygenation (Thavasothy et al, 2002 ; Edmonds et al, 2004 ; Hessel et al, 2014 ). Cranial bone anomalies, frontal sinus inflammation, dyshemoglobinemias like local or systemic pathologies are also reported to be the potential artifact factors for NIRS recordings (Gopinath et al, 1995 ; de Letter et al, 1998 ; Madsen et al, 2000 ; Sehic and Thomas, 2000 ; Boulos et al, 2007 ; McRobb et al, 2011 ). In addition, NIRS is also susceptible to ambient light and motion artifacts of relative movement between an optical fiber and the scalp.…”

The Accuracy of Pulse Spectroscopy for Detecting Hypoxemia and Coexisting Methemoglobin or Carboxyhemoglobin

“…[27][28][29][30][31] The ability to diagnose suspected cases of CO exposure or elevated MetHb levels in a timely manner and to avoid unnecessary invasive testing requires good sensitivity and specificity. Detecting elevated COHb and MetHb A rms = root-mean-square error; Bias = SpHbCO − COHb; COHb = carboxyhemoglobin level from arterial blood samples; limits of agreement (with 95% confidence intervals) = mean bias ± 1.96•SD (adjusted for repeated measures), which represents 95% of expected data; Sao 2 = functional oxygen saturation from arterial blood samples; SpHbCO = carboxyhemoglobin level read by pulse spectroscopy; Precision = SD of bias.…”