Erythropoietin in cyanotic heart disease.
We hypothesized that children with cyanotic congenital heart disease and moderate hypoxemia, as a result of erythrocytosis, and adequate iron stores would have low serum erythropoietin titers, low tissue oxygen delivery, and normal red cell 2,3-diphosphoglycerate (DPG) concentrations. We assessed hemoglobin levels, aortic oxygen saturation, iron stores, red cell 2,3-DPG, oxygen consumption, and systemic O2 transport in 19 hypoxemic patients, aged 3 months to 8 years. Low erythropoietin titers (less than 30 mU/dl) were found in 14 patients. Patients with high erythropoietin titers had lower Pao2 (36 +/- 7 vs 49 +/- 7 mm Hg, p less than 0.01), lower aortic saturation (68 +/- 12 vs 81 +/- 9%, p less than 0.01), and higher red cell 2,3-DPG (2.47 +/- 0.34 vs 3.23 +/- 0.73 mumol/ml, p less than 0.01). Aortic oxygen saturation higher than 80% was associated with a low erythropoietin titer and a hemoglobin level below that associated with hyperviscosity. The relationship between aortic oxygen saturation and hemoglobin concentration was strong (r = 0.77). These data suggest that for children less than 8 years of age, adequate compensation for moderate hypoxemia can occur with moderate increases in hemoglobin levels.
Gidding
S S
SS
Children's Memorial Hospital, Chicago, IL 60614.
Stockman
J A
JA
D019794:2,3-Diphosphoglycerate; D002648:Child; D002675:Child, Preschool; D003490:Cyanosis / Q000097:blood* / Q000151:congenital; D004163:Diphosphoglyceric Acids / Q000097:blood; D004921:Erythropoietin / Q000097:blood*; D005260:Female; D006330:Heart Defects, Congenital / Q000097:blood*; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D000860:Hypoxia / Q000097:blood; D007223:Infant; D007501:Iron / Q000097:blood; D008297:Male; D010100:Oxygen / Q000097:blood; D010101:Oxygen Consumption; D011086:Polycythemia / Q000097:blood
D004163:Diphosphoglyceric Acids; D006454:Hemoglobins; D004921:Erythropoietin; D019794:2,3-Diphosphoglycerate; D007501:Iron; D010100:Oxygen