Reduced Red Cell 2,3-Diphosphoglycerate and Adenosine Triphosphate, Hypophosphatemia, and Increased Hemoglobin-Oxygen Affinity after Cardiac Surgery

Abstract

Serum inorganic phosphorous was decreased significantly on the third postoperative day following cardiac surgery in 18 patients initially studied. Reduced plasma inorganic phosphate has been shown to cause a reduced concentration of red cell organic phosphates, an important determinant of hemoglobin-oxygen affinity. Therefore, 10 consecutive patients were studied to determine if reduced 2,3-diphosphoglycerate (DPG) and adenosine triphosphate (ATP) concentration and increased hemoglobin-oxygen affinity accompanied the fall in serum inorganic phosphate concentration. A significant fall in 2,3-DPG and an increase in hemoglobin-oxygen affinity was present in red cells of patients studied on the first postoperative day. A reduction in red cell ATP was also present and persisted for 5 days during which time red cell 2,3-DPG returned to levels which were in excess of preoperative values. The reduction in serum inorganic phosphorous followed the reduction in red cell 2,3-DPG and correlated with the reduction in ATP. The latter changes may indicate the diversion of glucose and more specifically 1,3-DPG into the Rapoport-Leubering pathway away from ATP generation at the phosphoglycerate kinase step and the utilization of plasma inorganic phosphate for 2,3-DPG resynthesis. Neither the transfusion of stored blood nor the effect of cardiopulmonary bypass fully explained the reduction in red cell 2,3-DPG and the inefficiency of hemoglobin function postoperatively. Further studies in postsurgical patients are needed to clarify the cause of the changes observed since they are potentially deleterious, especially in the subject with compromised cardiovascular and pulmonary function.

Erythrocyte Adenosine Triphosphate and 2,3-Diphosphoglycerate after Human Renal Transplantation: Dissociation from Hypophosphataemia

“…Although no actual measurements were done, an increase in pH would increase the enzymatic activity and the amounts of the compounds by accelerating the glycolytic rate and would tend to confirm the observations that blood pH is a more important regulator of erythrocyte glycolysis than the serum inorganic phosphate. Our studies in the post-transplant patient contrast with the observations of Ditzel (1973) of persistent decrease in erythrocyte 2,3-DPG in patients that have persistent hypophosphataemia after correction of diabetic ketoacidosis, and those of Young, Lichtman & Cohen (1973) which demonstrated a significant correlation between circulating serum phosphate concentrations and erythrocyte ATP and 2,3-DPG in patients studied immediately after cardiovascular surgery.…”

Decreased Erythrocyte Deformability After Transfusion and the Effects of Erythrocyte Storage Duration

“…The various components of the storage lesion include depletion of nitric oxide, 9 2,3-diphosphoglycerate (DPG), 10 and adenosine triphosphate (ATP); 11 increased free hemoglobin concentration from hemolysis; 9 and increased erythrocyte aggregability. 12 Storage-related changes in cell membrane structure and function include membrane phospholipid vesiculation, 13 protein oxidation, 14 lipid peroxidation, 15 and loss of cell membrane deformability.…”

Pharmacologic Manipulation of Human Erythrocyte 2,3-Diphosphoglycerate Levels by Prednisone Administration

“…We cannot attribute the action of prednisone t o this mechanism since serum inorganic phosphate levels I initially fell while 2,3-DPG levels started t o rise, as has also been observed by other researchers (18, 24). In patients with low 2,3-DPG levels secondary to transfusions during cardiac surgery, Young et al (24) have proposed that decreased serum I inorganic phosphate levels after initiation of resynthesis of ' 2,3-DPG may be due to accelerated utilization of plasma inorganic phosphates in the synthesis of organic phosphates.…”