Red blood cell 2,3-diphosphoglycerate concentration and in vivo P50 during early critical illness*

Ibrahim, Ezz el din S; McLellan, Stuart; Walsh, Timothy

doi:10.1097/01.ccm.0000181675.39370.3d

Cited by 26 publications

(10 citation statements)

References 36 publications

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“…Acquired RBC injuries in the critically ill population are commonly observed, with the following reports of specific alterations that impair O 2 delivery: increased adhesion to endothelium(36), decreased deformability, decreased hemoglobin (Hb) content(16, 37), increased O 2 affinity(17, 38), constrained energy metabolism and impaired antioxidant capacity(18), as well as abnormal nitric oxide processing (and vascular signaling)(19). Each of these pathologies adversely influence tissue O 2 delivery(20), by diminishing either blood flow or O 2 release(17) itself. It is important to note that the circulating RBC population is comprised by subpopulations of differing physiological reserve/resilience (e.g.…”

Section: Discussionmentioning

confidence: 99%

“…Such acquired RBC dysfunction is reported to result in: increased adhesion to endothelium, decreased deformability, decreased hemoglobin (Hb) content(16), increased O 2 affinity(17), constrained energy metabolism and impaired antioxidant capacity(18), as well as abnormal nitric oxide processing (and vascular signaling)(19). Each of these pathologies may adversely influence tissue O 2 delivery(20), by either impairing blood flow or O 2 release(17) itself. We considered the possibility that the changes in RDW observed in the critically ill may relate to these RBC injuries and thereby, serve as a biomarker for impaired RBC status with regard to O 2 delivery capacity and explain the observed association between this metric and outcome.…”

Section: Introductionmentioning

confidence: 99%

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RBC Distribution Width: Biomarker for Red Cell Dysfunction and Critical Illness Outcome?*

Said¹,

Spinella²,

Hartman³

et al. 2017

Pediatric Critical Care Medicine

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Objective Red blood cell distribution width (RDW) is reported to be an independent predictor of outcome in adults with a variety of conditions. We sought to determine if RDW is associated with morbidity or mortality in critically ill children. Design Retrospective observational study. Setting Tertiary pediatric intensive care unit. Patients All admissions to Saint Louis Children’s Hospital Pediatric Intensive Care Unit between 1/1/2005 and 12/31/2012. Interventions We collected demographics, laboratory values, hospitalization characteristics and outcomes. We calculated the relative change in RDW (R-RDW) from admission (A-RDW) to the highest RDW during the first 7 days of hospitalization. Our primary outcome was ICU mortality or use of ECMO as a composite. Secondary outcomes were ICU- and ventilator-free days. Measurements and main results We identified 3,913 eligible subjects with an estimated mortality (by PIM2) of 2.94±9.25% and an actual ICU mortality of 2.91%. For the study cohort, A-RDW was 14.12±1.89% and R-RDW was +2.63±6.23%. On univariate analysis, both A-RDW and R-RDW correlated with mortality or use of ECMO (OR=1.19 [95% CI: 1.12–1.27] and OR=1.06 [95% CI: 1.04–1.08], respectively, p<0.001). After adjusting for confounding variables, including severity of illness, both A-RDW (OR=1.13, 95% CI 1.03–1.24) and R-RDW (OR=1.04, 95% CI 1.01–1.07) remained independently associated with ICU mortality or use of ECMO. A-RDW and R-RDW both weakly correlated with fewer ICU-free (r2=0.038) and ventilator-free days, (r2=0.05), (p<0.001). Conclusions Independent of illness severity in critically ill children, A-RDW is associated with ICU mortality and morbidity. These data suggest that RDW may be a biomarker for RBC injury that is of sufficient magnitude to influence critical illness outcome, possibly via oxygen delivery impairment.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

RBC Distribution Width: Biomarker for Red Cell Dysfunction and Critical Illness Outcome?*

Said¹,

Spinella²,

Hartman³

et al. 2017

Pediatric Critical Care Medicine

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“…There remains some uncertainty, however, as to the effect of sepsis on RBC 2,3-BPG levels [ 67 ]. An experimental pilot study using endotoxemic mice suggested that, in the early hypoglycemic phase of endotoxemia, the RBC increased its 2,3-BPG level [ 68 ], suggesting the RBC was attempting to release more oxygen in hypoxic regions.…”

Section: Hemoglobin Oxygen Binding and 23-bisphosphoglycerate (2mentioning

confidence: 99%

“…However, in critically ill and septic patients, acidemia, hypophosphatemia and transfusion of 2,3-BPG depleted blood are all factors that can shift the ODC to the left, decrease the P 50 [ 62 ], increase Hb affinity for oxygen and decrease oxygen release. Numerous experimental and clinical studies have reported decreased levels of RBC 2,3-BPG and reduced P 50 including in endotoxemic baboons [ 68 ], and critically ill and sepsis patients [ 61 , 67 , 69 ], respectively.…”

Section: Hemoglobin Oxygen Binding and 23-bisphosphoglycerate (2mentioning

confidence: 99%

“…Acidemia reduces the affinity of hemoglobin for oxygen (Bohr effect), but over time, also inhibits the synthesis of 2,3-BPG, which opposes the Bohr effect. However, while studies of critically ill and septic patients indicate that 2,3-BPG may decrease [ 61 , 69 ], it may also remain unchanged [ 67 ]. Additionally, Ibrahim et al [ 67 ] reported there was no difference in 2,3-BPG levels between ICU survivors and non-survivors.…”

Section: Hemoglobin Oxygen Binding and 23-bisphosphoglycerate (2mentioning

confidence: 99%

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The Effect of Sepsis on the Erythrocyte

Bateman

Sharpe

Singer

et al. 2017

IJMS

125

131

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Sepsis induces a wide range of effects on the red blood cell (RBC). Some of the effects including altered metabolism and decreased 2,3-bisphosphoglycerate are preventable with appropriate treatment, whereas others, including decreased erythrocyte deformability and redistribution of membrane phospholipids, appear to be permanent, and factors in RBC clearance. Here, we review the effects of sepsis on the erythrocyte, including changes in RBC volume, metabolism and hemoglobin’s affinity for oxygen, morphology, RBC deformability (an early indicator of sepsis), antioxidant status, intracellular Ca2+ homeostasis, membrane proteins, membrane phospholipid redistribution, clearance and RBC O2-dependent adenosine triphosphate efflux (an RBC hypoxia signaling mechanism involved in microvascular autoregulation). We also consider the causes of these effects by host mediated oxidant stress and bacterial virulence factors. Additionally, we consider the altered erythrocyte microenvironment due to sepsis induced microvascular dysregulation and speculate on the possible effects of RBC autoxidation. In future, a better understanding of the mechanisms involved in sepsis induced erythrocyte pathophysiology and clearance may guide improved sepsis treatments. Evidence that small molecule antioxidants protect the erythrocyte from loss of deformability, and more importantly improve septic patient outcome suggest further research in this area is warranted. While not generally considered a critical factor in sepsis, erythrocytes (and especially a smaller subpopulation) appear to be highly susceptible to sepsis induced injury, provide an early warning signal of sepsis and are a factor in the microvascular dysfunction that has been associated with organ dysfunction.

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Concentration of 2,3 bisphosphoglycerate in cattle affected with acute ruminal acidosis

Moosa

Al-Obaidi

Mustafa

et al. 2021

Veterinary Medicine & Sci

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The main objective of the study conducted here was to estimate the concentration of 2,3‐Bisphosphoglycerate (2,3‐BPG), 1,3‐Bisphosphoglycerate (1,3‐BPG), bisphospho‐glycerate mutase (BPGM) and 3‐phosphoglycerate (3PG) in cattle clinically diagnosed with acute ruminal acidosis. A secondary objective was to examine the physical and chemical characteristics of the ruminal fluid in affected cattle. A total of 20 cattle clinically diagnosed with acute ruminal acidosis and eight clinically normal cattle were included in this study. The results showed that decrease of ruminal pH changed the ruminal fluid colour, odour and consistency, as well as decreased the sedimentation time, increased the methylene blue reduction time, and decreased ruminal microflora motility. The study indicated that the concentration of 2,3‐BPG, BPGM and BPGP decreased with the decrease of ruminal pH, while 3‐PG concentration was not affected with the decrease of ruminal pH. In conclusion, 2,3‐BPG could play a role in the pathogenesis of ruminal acidosis, and thus, the intravenous administration of sodium bicarbonate is important, particularly in severe cases, to correct any systemic acidosis that can decrease 2,3‐BPG concentration and results in tissue hypoxia.

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Red blood cell 2,3-diphosphoglycerate concentration and in vivo P50 during early critical illness*

Cited by 26 publications

References 36 publications

RBC Distribution Width: Biomarker for Red Cell Dysfunction and Critical Illness Outcome?*

RBC Distribution Width: Biomarker for Red Cell Dysfunction and Critical Illness Outcome?*

The Effect of Sepsis on the Erythrocyte

Concentration of 2,3 bisphosphoglycerate in cattle affected with acute ruminal acidosis

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