Erythrocyte 2,3-diphosphoglycerate depletion associated with hypophosphatemia detected by routine arterial blood gas analysis

Abstract

Objective: to describe a clinical case where an extremely low erythrocyte 2,3-diphosphoglycerate concentration (2,3-DPG) was discovered by routine blood gas analysis supplemented by computer calculation of derived quantities. The finding of a low 2,3-DPG revealed a severe hypophosphatemia.

Design: open uncontrolled study of a patient case.

Setting: intensive care observation during 41 days.

Patient: A 44 year old woman with an abdominal abscess.

Interventions: Surgical drainage, antibiotics and parented nutrition.

Measurements and results: daily routine blood gas analyses with computer calculation of the hemoglobin oxygen affinity and estimation of the 2,3-DPG. An abrupt decline of 2,3-DPG was observed late in the course coincident with a pronounced hypophosphatemia. The fall in 2,3-DFG was verified by enzymatic analysis.

Conclusion: 2,3-DPG may be estimated by computer calculation of routine blood gas data. A low 2,3-DPG which may be associated with hypophosphatemia causes an unfavorable increase in hemoglobin oxygen affinity which reduces the oxygen release to the tissues.

Key Words:

• Computer programs
• hemoglobin oxygen affinity
• oxygen status algorithm