Use of breath carbon monoxide measurements to assess erythrocyte survival in subjects with chronic diseases

Abstract

Anemia is very common in patients with chronic diseases. To determine the role of increased red blood cell (RBC) turnover in such subjects, we estimated RBC survival in three groups of chronically ill patients using a simple technique in which RBC life span is estimated via measurements of breath carbon monoxide concentration. The study groups consisted of subjects with: (1) osteoarthritis, (2) rheumatoid arthritis, and (3) anemia who were hospitalized for treatment of a variety of chronic illnesses. None of the anemic subjects had evidence of hemorrhage, a deficiency state, or a marrow abnormality to account for their reduced hemoglobin concentration. Subjects with osteoarthritis had a mean RBC life span (127 ± 25 days) that did not differ significantly from normal (122 ± 23 days). In contrast, RBC life span was significantly reduced (P < 0.001) in both the rheumatoid arthritis subjects (90 ± 15 days) and the anemic, hospitalized patients (87 ± 33 days). The hemoglobin concentration of the rheumatoid patients was near normal (13.5 ± 1.5 g/dl), indicating that the marrow was compensating for the reduced RBC life span, whereas no such compensation was apparent in the anemic, chronically ill subjects. We conclude that a modest (approximately 25%) reduction in RBC life span commonly occurs in patients with chronic disease, and this reduction becomes clinically relevant in subjects whose marrow cannot respond with increased RBC output. Am. J. Hematol. 81:432-438, 2006. V V C 2006 Wiley-Liss, Inc.

Heme Catabolism by Heme Oxygenase-1 Confers Host Resistance to Mycobacterium Infection

“…The erythrocyte life span is reduced during anemia in chronic disease (43), a condition occurring during mycobacterial infections (44). Moreover, mice infected with Mycobacterium lepraemurium have increased erythrophagocytosis (45), implying a higher hemoglobin turnover and supporting the hypothesis that M are exposed to hemoglobin and therefore to heme during mycobacterial infection.…”

Correlation between Inflammatory Biomarkers and Red Blood Cell Life Span in Chronic Hemodialysis Patients

“…The endogenous CO is the difference between the average alveolar and home ambient air CO concentrations. The endogenous CO concentration and RBCLS were computed as previously reported [15,16,17]. …”

Quantitative assessment of the multiple processes responsible for bilirubin homeostasis in health and disease

“…This reaction releases the alpha-methene carbon as carbon monoxide (CO) and biliverdin, which is rapidly reduced to bilirubin via the activity of biliverdin reductase. Since heme catabolism is the only endogenous source of CO in humans, and this CO is quantitatively excreted in expired air, breath CO measurements (corrected for ambient CO) provide a noninvasive means of estimating bilirubin production and red blood cell (RBC) turnover, a measurement not provided by any other simple methodology 7,8. About 250 mg/day of bilirubin is produced by normal adult humans; roughly 75% of this is derived from circulating hemoglobin, while the other 25% is derived from catabolism of other heme compounds, primarily cytochromes.…”