Measuring Human Hemolysis Clinically and in Extreme Environments Using Endogenous Carbon Monoxide Elimination

Shahin, Nibras; Louati, Hakim; Trudel, Guy

doi:10.1007/s10439-020-02473-5

Cited by 5 publications

(13 citation statements)

References 25 publications

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“…For these reasons, we chose endogenous CO elimination as a precise, direct and quantitative marker of hemolysis as the primary outcome measure of the study. We measured CO elimination following the methods of Shahin et al 7 . Briefly, upon waking up, after a 20-s breath hold, astronauts exhaled through a mouthpiece connected to a one-way valve sequentially discarding 400 ml of air from airways and filling a 750-ml collection bag with alveolar air (Supplementary Video 1 ).…”

Section: Methodsmentioning

confidence: 99%

“…Canisters sampled on the ISS were stowed and boarded the next Earth-bound reentry vehicle. These methods accommodated for changes in pressure, temperature and vibration and maintained stable [CO] for at least 11 months 7 . Both air samples were extracted from the canisters and run through a gas chromatograph with a reduction gas detector.…”

Section: Methodsmentioning

confidence: 99%

“…The quantification of CO molecules eliminated is therefore a direct measure of hemolysis. Recently developed methods to precisely quantify endogenous CO now permit the measurement of hemolysis in space 7 . Using these methods, 20 participants showed increased hemolysis (by an average of 23%) throughout 60 days of the antiorthostatic bed-rest microgravity analogue 8 .…”

Section: Mainmentioning

confidence: 99%

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Hemolysis contributes to anemia during long-duration space flight

Trudel

Shahin

Ramsay

et al. 2022

Nat Med

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Anemia in astronauts has been noted since the first space missions, but the mechanisms contributing to anemia in space flight have remained unclear. Here, we show that space flight is associated with persistently increased levels of products of hemoglobin degradation, carbon monoxide in alveolar air and iron in serum, in 14 astronauts throughout their 6-month missions onboard the International Space Station. One year after landing, erythrocytic effects persisted, including increased levels of hemolysis, reticulocytosis and hemoglobin. These findings suggest that the destruction of red blood cells, termed hemolysis, is a primary effect of microgravity in space flight and support the hypothesis that the anemia associated with space flight is a hemolytic condition that should be considered in the screening and monitoring of both astronauts and space tourists.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Mainmentioning

confidence: 99%

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Hemolysis contributes to anemia during long-duration space flight

Trudel

Shahin

Ramsay

et al. 2022

Nat Med

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“…6). CO elimination was performed according to Shahin 83 , which involves replication of the measures, and implemented major improvements over prior methods 15 . Briefly, alveolar and ambient air samples were collected upon waking at 07:00 hours.…”

Section: Quantification Of Hemolysismentioning

confidence: 99%

Six degrees head-down tilt bed rest caused low-grade hemolysis: a prospective randomized clinical trial

et al. 2021

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This study aimed to measure hemolysis before, during and after 60 days of the ground-based spaceflight analog bed rest and the effect of a nutritional intervention through a prospective randomized clinical trial. Twenty male participants were hospitalized for 88 days comprised of 14 days of ambulatory baseline, 60 days of 6° head-down tilt bed rest and 14 days of reambulation. Ten participants each received a control diet or daily polyphenol associated with omega-3, vitamin E, and selenium supplements. The primary outcome was endogenous carbon monoxide (CO) elimination measured by gas chromatography. Hemolysis was also measured with serial bilirubin, iron, transferrin saturation blood levels and serial 3-day stool collections were used to measure urobilinoid excretion using photometry. Total hemoglobin mass (tHb) was measured using CO-rebreathing. CO elimination increased after 5, 11, 30, and 57 days of bed rest: +289 ppb (95% CI 101–477 ppb; p = 0.004), +253 ppb (78–427 ppb; p = 0.007), +193 ppb (89–298 ppb; p = 0.001) and +858 ppb (670–1046 ppb; p < 0.000), respectively, compared to baseline. Bilirubin increased after 20 and 49 days of bed rest +0.8 mg/l (p = 0.013) and +1.1 mg/l (p = 0.012), respectively; and iron increased after 20 days of bed rest +10.5 µg/dl (p = 0.032). The nutritional intervention did not change CO elimination. THb was lower after 60 days of bed rest −0.9 g/kg (p = 0.001). Bed rest enhanced hemolysis as measured through all three by-products of heme oxygenase. Ongoing enhanced hemolysis over 60 days contributed to a 10% decrease in tHb mass. Modulation of red blood cell control towards increased hemolysis may be an important mechanism causing anemia in astronauts.

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“…This renders the COHb contribution from normally generated endogenous CO in most situations essentially negligible in comparison with environmental increases. Individuals in extreme high-altitude environments, such as astronauts in the microgravity conditions of space or acclimatized mountain climbers descending from altitude, may suffer from an increase in endogenous CO production due to the selective destruction of young red blood cells (called neocytes), known as neocytolysis (19,20).…”

Section: Endogenous Co Productionmentioning

confidence: 99%

Endogenous carbon monoxide due to hemolytic anemia: A forensic red herring

Hyson

Wehbie

Haikal

et al. 2022

Journal of Forensic Sciences

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Carbon monoxide (CO) toxicity associated with exposure to an environmental, exogenous source, is routinely investigated in the field of forensics. Paramedics responded to the home of a 60-year-old woman who complained of persistent nausea, dizziness, and fatigue. Her initial carboxyhemoglobin (COHb) saturation was 25% as measured by paramedics in the field via pulse CO-oximetry (SpCO) and was, 2 hours later, confirmed by hospital laboratory spectrophotometric analysis to be 16% after initial treatment in the emergency department. The clinical presentation of environmental CO exposure and subsequent death notification to the North Carolina Office of the Chief Medical Examiner prompted an extensive investigation into the suspected residential source of CO, which ultimately ruled out all exogenous sources. The medicolegal death investigator later discovered an updated hematology consultation note, which determined the actual source of the CO to be endogenously produced from disease. Herein, we report an unusual fatality involving enhanced endogenous CO production caused by warm autoimmune hemolytic anemia. This unique case report and brief literature review of disease-related elevation of endogenous CO will shed light on this lesser-known phenomenon alerting the forensic community to its potential occurrence and need for consideration when sources of environmental exposure have been exhausted. K E Y W O R D Scarbon monoxide toxicity, carboxyhemoglobin, endogenous carbon monoxide, forensic pathology, medicolegal death investigation, warm autoimmune hemolytic anemia Highlights• Endogenous carbon monoxide (CO) production can reach clinically measurable levels in the setting of hemolytic anemia.• Endogenous CO may mimic symptoms of an environmental exposure in forensic investigations.• Among cases of warm autoimmune hemolytic anemia, those mediated by complement component 3 (C3) can sometimes be fatal.

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Measuring Human Hemolysis Clinically and in Extreme Environments Using Endogenous Carbon Monoxide Elimination

Cited by 5 publications

References 25 publications

Hemolysis contributes to anemia during long-duration space flight

Hemolysis contributes to anemia during long-duration space flight

Six degrees head-down tilt bed rest caused low-grade hemolysis: a prospective randomized clinical trial

Endogenous carbon monoxide due to hemolytic anemia: A forensic red herring

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