Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2015 May;62(5):912-4.
doi: 10.1002/pbc.25447. Epub 2015 Feb 14.

Point-of-care end-tidal carbon monoxide reflects severity of hemolysis in sickle cell anemia

Ashutosh Lal  1 , Lasandra Patterson, Alisa Goldrich, Anne Marsh
Affiliations
Comparative Study

Point-of-care end-tidal carbon monoxide reflects severity of hemolysis in sickle cell anemia

Ashutosh Lal et al. Pediatr Blood Cancer. 2015 May.

Abstract

Carbon monoxide (CO) production from heme catabolism is increased with hemolysis. A portable end-tidal CO (ETCO) monitor was used to analyze breath samples in 16 children with sickle cell anemia (SCA, 5-14 years). Median (range) ETCO for SCA was 4.35 ppm (1.8-9.7) versus 0.80 ppm (0.2-2.3) for controls (P < 0.001). ETCOc >2.1 ppm provided sensitivity and specificity of 93.8% (69.8-99.8%) for detecting SCA. ETCO correlated with reticulocytosis (P = 0.015) and bilirubin (P = 0.009), and was 32% lower in children receiving hydroxyurea (P = 0.09). Point-of-care ETCO analysis may prove useful for non-invasive monitoring of hemolysis and as a screening test for SCA.

Keywords: hemoglobinopathies; red blood cell disorders; sickle cell anemia.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest: None

Figures

Figure 1
Figure 1
(A) End-tidal carbon monoxide concentration in children with sickle cell anemia (SCA) and healthy age-matched controls (n=16 for both groups). Whiskers extend from 10-90th percentile (+: mean). (B) Receiver-operator characteristic curve (solid line) for ETCOc in children with or without a diagnosis of SCA. A threshold ETCOc value of 2.1 ppm provided a sensitivity and specificity of 93.8% to differentiate between the two groups. (Dotted line: line of identity).
Figure 2
Figure 2
Association of end-tidal carbon monoxide concentration (ETCOc) with absolute reticulocyte count (Figure 2A, n=15), and serum bilirubin concentration (Figure 2B, n=12).
See this image and copyright information in PMC

References

    1. Owens EO. Endogenous carbon monoxide production in disease. Clin Biochem. 2010;43:1183–1188. - PubMed
    1. Gozzelino R, Jeney V, Soares MP. Mechanisms of cell protection by heme oxygenase-1. Annu Rev Pharmacol Toxicol. 2010;50:323–354. - PubMed
    1. Coburn RF, Williams WJ, Kahn SB. Endogenous carbon monoxide production in patients with hemolytic anemia. J Clin Invest. 1966;45:460–468. - PMC - PubMed
    1. Wald NJ, Idle M, Boreham J, Bailey A. Carbon monoxide in breath in relation to smoking and carboxyhaemoglobin levels. Thorax. 1981;36:366–369. - PMC - PubMed
    1. James EB, Vreman HJ, Wong RJ, Stevenson DK, Vichinsky E, Schumacher L, Hall JY, Simon J, Golden DW, Harmatz P. Elevated exhaled carbon monoxide concentration in hemoglobinopathies and its relation to red blood cell transfusion therapy. Pediatr Hematol Oncol. 2010;27:112–121. - PubMed

Publication types