title: Hb Grifton [α87(F8)His→Pro; HBA1: C.263A > C (or HBA2)] Causes Abnormal Pulse Oximetry Measurements.
abstract: An asymptomatic toddler and his mother consistently demonstrated low transcutaneous pulse oximetry (SpO2) measurements, discordant with normal arterial blood gas analyses while breathing room air. Previous evaluations by medical teams were unable to identify an etiology of their perceived hypoxia. Further investigation revealed that the boy carried an abnormal variant, Hb Grifton or α87(F8)His→Pro; HBA1: c.263A > C (or HBA2), discovered on newborn screening, which was not suspected as the underlying cause of his abnormal pulse oximetry readings until an inpatient admission to our hospital for asymptomatic "hypoxia," where he was found to share these same characteristics with his mother. We showed that a difference in light absorption between the oxygenated Hb Grifton variant and oxygenated Hb A resulted in erroneous pulse oximetry values. This phenomenon has previously been reported in a handful of other variant Hbs. Astute clinical suspicion, in conjunction with laboratory testing leading to correct diagnoses of variant Hbs, may prevent expensive work-ups and unnecessary medical treatments for asymptomatic patients falsely presumed to be hypoxemic based on low pulse oximetry measurements.
authors.affiliation: a Department of Pediatrics , Carl R. Darnall Army Medical Center , Fort Hood , TX , USA .
authors.forename: Aubri M
authors.initials: AM
authors.lastname: Waters
authors.affiliation: b Department of Pediatrics , Pediatric Pulmonology, Madigan Army Medical Center , Tacoma , WA , USA .
authors.forename: Jason B
authors.initials: JB
authors.lastname: Caboot
authors.affiliation: c Division of Hematology and Thromboembolism , McMaster University , Hamilton , ON , Canada .
authors.forename: Madeleine M
authors.initials: MM
authors.lastname: Verhovsek
authors.affiliation: d Department of Pediatrics , Pediatric Hematology/Oncology, Madigan Army Medical Center , Tacoma , WA , USA.
authors.forename: David P
authors.initials: DP
authors.lastname: Harper
authors.affiliation: d Department of Pediatrics , Pediatric Hematology/Oncology, Madigan Army Medical Center , Tacoma , WA , USA.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Forouhar
mesh_terms: D000328:Adult; D001784:Blood Gas Analysis; D002675:Child, Preschool; D003951:Diagnostic Errors; D005260:Female; D006455:Hemoglobins, Abnormal / Q000032:analysis / Q000235:genetics; D006801:Humans; D000860:Hypoxia / Q000175:diagnosis; D008297:Male; D010092:Oximetry / Q000592:standards*; D010108:Oxyhemoglobins / Q000032:analysis*
chemical_list: D006455:Hemoglobins, Abnormal; D010108:Oxyhemoglobins
keywords: Hb Grifton; hemoglobinopathy; pulse oximetry; spectrophotometry