title: Seeking optimal relation between oxygen saturation and hemoglobin concentration in adults with cyanosis from congenital heart disease.
abstract: In patients with cyanosis from congenital heart disease, erythropoiesis is governed by many factors that can alter the expected relation between the oxygen saturation (O(2sat)) and hemoglobin concentration. We sought to define the relation between the O(2sat) and hemoglobin in such patients and to predict an ideal hemoglobin concentration for a given O(2sat). Adults with congenital heart defects and cyanosis were studied prospectively using blood tests and exercise testing. Nonoptimal hemoglobin was defined as any evidence of inadequate erythropoiesis (i.e., iron, folate, or vitamin B(12) deficiency, increased erythropoietin, reticulocytosis, or a right-shifted oxygen-hemoglobin curve). For patients without these factors, a linear regression equation of hemoglobin versus O(2sat) was used to predict the optimal hemoglobin for all patients. Of the 65 patients studied, 21 met all the prestudy criteria for an optimal hemoglobin. For all patients, no correlation was found between O(2sat) and hemoglobin (r = -0.22). However, a strong linear correlation was found for those meeting the criteria for optimal hemoglobin (r = -0.865, p <0.001). The optimal hemoglobin regression equation was as follows: predicted hemoglobin = 57.5 - (0.444 × O(2sat)). A negative correlation was found between the hemoglobin difference (predicted minus measured) and exercise duration on cardiopulmonary exercise testing (r = -0.396, p = 0.005) and the 6-minute walk distance (r = -0.468, p <0.001). In conclusion, a strong relation between O(2sat) and hemoglobin concentration can be shown in stable cyanotic patients and used to predict an optimal hemoglobin. This relation might be useful in defining functional anemia in this group.
authors.affiliation: Adult Congenital Heart Disease Program, Oregon Health and Sciences University, Portland, USA. brobergc@ohsu.edu
authors.forename: Craig S
authors.initials: CS
authors.lastname: Broberg
authors.forename: Ananda R
authors.initials: AR
authors.lastname: Jayaweera
authors.forename: Gerhard P
authors.initials: GP
authors.lastname: Diller
authors.forename: Sanjay K
authors.initials: SK
authors.lastname: Prasad
authors.forename: Swee Lay
authors.initials: SL
authors.lastname: Thein
authors.forename: Bridget E
authors.initials: BE
authors.lastname: Bax
authors.forename: John
authors.initials: J
authors.lastname: Burman
authors.forename: Michael A
authors.initials: MA
authors.lastname: Gatzoulis
mesh_terms: D000328:Adult; D000465:Algorithms; D003490:Cyanosis / Q000097:blood* / Q000151:congenital; D005080:Exercise Test; D005260:Female; D006330:Heart Defects, Congenital / Q000097:blood* / Q000503:physiopathology; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood*; D010101:Oxygen Consumption; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012016:Reference Values; D012680:Sensitivity and Specificity
chemical_list: D006454:Hemoglobins; D010100:Oxygen