Impact of hemoglobin concentration and affinity for oxygen on tissue oxygenation: the case of hemoglobin-based oxygen carriers.

In patients undergoing exchange-transfusion with hemoglobin (Hb)-based oxygen (O₂) carriers (HBOC), native Hb coexists with newly transfused Hb. The two Hb types share the same arterial and venous PO₂, but their affinities for O₂ vary. A simple spreadsheet model is described aiming at evaluating the contribution of each Hb type to the overall O₂ transport characteristics as a function of the batch Hb concentration and O₂ affinity in the HBOC solution, of the fraction of exchange-transfused blood/HBOC, and of the arterial PO₂. This model helps to yield a quantitative estimate of how tissues with high or low O₂ extraction respond to the changes cited above. The results show that the higher the exchange-transfusion ratio, the O₂ transport to tissues becomes progressively impaired. However, this effect is more critical at low batch Hb concentration and high O₂ affinity of the HBOC, especially for tissues/organs with high O₂ extraction, whereas the arterial PO₂ does not appear as critical.