Leukocyte larceny: A cause of spurious hypoxemia

Fox, Michael J.; Brody, Jerome S.; Weintraub, Lewis R.; Szymanski, John M.; O’Donnell, Carl R.

doi:10.1016/0002-9343(79)90728-9

Cited by 60 publications

(39 citation statements)

References 10 publications

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“…10 However, methemoglobinemia is unlikely to explain spurious hypoxemia, as it is associated with normal P aO 2 21 and could not account for the extremely low P aO 2 observed in the present study and others. 5,9,22,23 Overall, we described a poor correlation between S aO 2 and S pO 2 in the presence of a WBC count Ͼ 50 ϫ 10 9 /L, as attested by the low coefficient of determination (r 2 ϭ 0.19) observed when plotting S pO 2 versus S aO 2 . Although correlation analysis may not be the best approach to compare S aO 2 and S pO 2 , a large meta-analysis of 74 studies reported an r 2 of 0.8 between S aO 2 and S pO 2 , 24 much higher than the r 2 of 0.19 that we observed for subjects with WBC count Ͼ 50 ϫ 10 9 /L.…”

Section: Discussionmentioning

confidence: 69%

“…The pathophysiology of spurious hypoxemia has been thought to involve oxygen consumption by increased numbers of leukocytes inside the syringes (leukocyte larceny) before analysis. 5 This hypothesis was supported by an in vitro study using continuous P O 2 measurement in blood samples from 5 hyperleukocytic leukemia subjects and also from granulocyte donors, where authors observed a progressive decrease in P O 2 in hyperleukocytic samples, reaching values as low as 20 mm Hg within 10 min. 16 This progressive decline was grossly proportional to WBC count and was not subsequently observed in the same subjects after cytoreductive therapy or in whole blood from the granulocyte donors.…”

Section: Discussionmentioning

confidence: 85%

“…The finding of artifactual decrease in P aO 2 due to increased oxygen consumption by WBCs in collected samples, has been described and referred to as spurious hypoxemia. 5 A clinically relevant decay in P aO 2 may occur as soon as 2 min in samples with WBC count as low as 55 ϫ 10 proportional to WBC count. 5 Several case reports have been published, [6][7][8][9] but other authors have emphasized that the hypoxemia observed during hyperleukocytosis might actually be real and reflect subtle pulmonary leukostasis.…”

Section: Introductionmentioning

confidence: 99%

“…5 A clinically relevant decay in P aO 2 may occur as soon as 2 min in samples with WBC count as low as 55 ϫ 10 proportional to WBC count. 5 Several case reports have been published, [6][7][8][9] but other authors have emphasized that the hypoxemia observed during hyperleukocytosis might actually be real and reflect subtle pulmonary leukostasis. 10 Published data come from small series, but no study has ever systematically investigated the reliability of P aO 2 and S aO 2 in this setting, probably because of the relative rarity of extreme hyperleukocytosis.…”

Section: Introductionmentioning

confidence: 99%

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Hypoxemia During Extreme Hyperleukocytosis: How Spurious?

Louw

Desai²,

Schneider³

et al. 2015

Respir Care

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BACKGROUND: Spurious hypoxemia has been described in case reports during extreme hyperleukocytosis and has led to recommendations for immediate cooling and analysis of arterial blood gases (ABGs). We sought to determine, in samples processed as recommended, the magnitude of spurious hypoxemia in acute leukemia subjects with hyperleukocytosis. METHODS: A retrospective chart review was conducted of all subjects admitted between 2003 and July 2014 for acute leukemia, who presented with white blood cell (WBC) count > 50 ؋ 10 9 cells/L and had ABGs performed. For each ABG, we collected P aO 2 , S aO 2 , simultaneous WBC count, and S pO 2 when available. Bland and Altman analysis was used to assess the agreement between S pO 2 and S aO 2 . RESULTS: One-hundred forty-six samples (from 45 subjects) were included, of which 57 samples (from 18 subjects) had data available for Bland and Altman analysis. Mean (S pO 2 ؊ S aO 2 ) was 2.5%, and 95% CI for limits of agreement between S pO 2 and S aO 2 was (؊10.1,15.1)%. The mean (S pO 2 -S aO 2 ) was significantly higher for WBC count > 100 ؋ 10 9 /L as compared with WBC count < 100 ؋ 10 9 /L (3.8% vs 0.4%, P ‫؍‬ .04), and the 95% CIs for limits of agreement were (؊10.3,18)% versus (؊7.9,8.6)%. S pO 2 and S aO 2 were poorly correlated (r 2 ‫؍‬ 0.19), whereas the difference (S pO 2 -S aO 2 ) was fairly correlated with WBC count (r 2 ‫؍‬ 0.44). Overall, 11 of 19 samples with WBC count > 150 ؋ 10 9 /L had P aO 2 < 55 mm Hg whereas S pO 2 was > 94%, the proportion being 5 of 62 samples for WBC count < 150 ؋ 10 9 /L (P < .001). Three subjects with WBC count > 150 ؋ 10 9 /L exhibited large S pO 2 to S aO 2 differences (10 -20%) before leukapheresis, which decreased to below 5% afterward. CONCLUSIONS: In subjects with acute leukemia and hyperleukocytosis, despite cooling and quickly analyzing the samples, we observed poor correlation and agreement between S pO 2 and S aO 2 , unacceptably low for WBC count > 100 ؋ 10 9 /L. Our results suggest that current guidelines may not totally prevent the diagnosis of spurious hypoxemia.

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Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Hypoxemia During Extreme Hyperleukocytosis: How Spurious?

Louw

Desai²,

Schneider³

et al. 2015

Respir Care

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“…1,2,10,[14][15][16][17] Ao contrário dos eritrócitos, cujo metabolismo é maioritariamente anaeróbio, os leucócitos têm um metabolismo predominantemente aeróbio, mas o seu consumo de oxigé-nio é habitualmente desprezível devido à sua pequena contribuição, em percentagem, para o volume de sangue total. Porém, quando em grande número (Fig.s 1 e 2), são capazes de consumir quantidades consideráveis de oxigénio.…”

Section: Caso Clínicounclassified

Sequestro Leucocitário de Oxigénio

Costa

Coelho

2016

Acta Med Port

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<p>The authors present a case of a 60-year-old male patient, previously diagnosed with B-cell chronic lymphocytic leukemia, who was admitted to the Emergency Room with dyspnea. The initial evaluation revealed severe anemia (Hgb = 5.0 g/dL) with hyperleukocytosis (800.000/µL), nearly all of the cells being mature lymphocytes, a normal chest X-ray and a low arterial oxygen saturation (89%; pulse oximetry). After red blood cell transfusion, Hgb values rose (9.0 g/dL) and there was a complete reversion of the dyspnea. Yet, subsequent arterial blood gas analysis, without the administration of supplemental oxygen, systematically revealed very low oxygen saturation values (~ 46%), which was inconsistent with the patient’s clinical state and his pulse oximetry values (~ 87%), and these values were not corrected by the administration of oxygen via non-rebreather mask. The investigation performed allowed to establish the diagnosis of oxygen leukocyte larceny, a phenomenon which conceals the true oxygen saturation due to peripheral consumption by leukocytes.</p>

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Grand Larceny at the Cellular Level

Vaisrub¹

1980

JAMA

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Leukocyte larceny: A cause of spurious hypoxemia

Cited by 60 publications

References 10 publications

Hypoxemia During Extreme Hyperleukocytosis: How Spurious?

Hypoxemia During Extreme Hyperleukocytosis: How Spurious?

Sequestro Leucocitário de Oxigénio

Grand Larceny at the Cellular Level

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