Interpreting sulfhemoglobin and methemoglobin in patients with cyanosis: An overview of patients with M-hemoglobin variants
Aruna Rangan
Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
Search for more papers by this authorMichelle E. Savedra
Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
Search for more papers by this authorCamila Dergam-Larson
Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
Search for more papers by this authorKenneth C. Swanson
Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
Search for more papers by this authorJessica Szuberski
Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
Search for more papers by this authorRonald S. Go
Department of Hematology and Oncology, Mayo Clinic, Rochester, MN, USA
Search for more papers by this authorTavanna R. Porter
Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
Search for more papers by this authorSarah E. Brunker
Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
Search for more papers by this authorMin Shi
Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
Search for more papers by this authorPhuong L. Nguyen
Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
Search for more papers by this authorJames D. Hoyer
Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
Search for more papers by this authorCorresponding Author
Jennifer L. Oliveira
Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
Correspondence
Jennifer L. Oliveira, 200 1st St SW, Hilton-7-24, Rochester MN, 55905, USA.
Email: [email protected]
Search for more papers by this authorAruna Rangan
Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
Search for more papers by this authorMichelle E. Savedra
Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
Search for more papers by this authorCamila Dergam-Larson
Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
Search for more papers by this authorKenneth C. Swanson
Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
Search for more papers by this authorJessica Szuberski
Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
Search for more papers by this authorRonald S. Go
Department of Hematology and Oncology, Mayo Clinic, Rochester, MN, USA
Search for more papers by this authorTavanna R. Porter
Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
Search for more papers by this authorSarah E. Brunker
Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
Search for more papers by this authorMin Shi
Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
Search for more papers by this authorPhuong L. Nguyen
Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
Search for more papers by this authorJames D. Hoyer
Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
Search for more papers by this authorCorresponding Author
Jennifer L. Oliveira
Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
Correspondence
Jennifer L. Oliveira, 200 1st St SW, Hilton-7-24, Rochester MN, 55905, USA.
Email: [email protected]
Search for more papers by this authorAbstract
Introduction
Methemoglobin (MetHb) and sulfhemoglobin (SHb) measurements are useful in the evaluation of cyanosis. When one or both values are elevated, additional analysis is important to establish the etiology of the disorder. Methemoglobinemia occurs from acquired or hereditary causes with diverse treatment considerations, while true sulfhemoglobinemia is only acquired and treatment is restricted to toxin removal. Some toxic exposures can result in a dual increase in MetHb and SHb. Hereditary conditions, such as M-Hemoglobin variants (M-Hbs), can result in increased MetHb and/or SHb values but are clinically compensated and do not require treatment if they are cyanotic but otherwise clinically well.
Methods
Herein, we report 53 hemoglobin variant cases that have associated MetHb and SHb levels measured by an adapted Evelyn-Malloy laboratory assay method.
Results
Our data indicate M-Hbs cause variable patterns of MetHb and SHb elevation in a fairly reproducible pattern for the particular variant. In particular, α globin chain M-Hbs can mimic acquired sulfhemoglobinemia due to an isolated increased SHb value.
Conclusion
If the patient appears clinically well other than cyanosis, M-Hbs should be considered early in the evaluation process to differentiate from acquired conditions to avoid unnecessary testing and treatment regimens and prompt genetic counseling.
CONFLICT OF INTEREST
The authors have no competing interests.
Open Research
DATA AVAILABILITY STATEMENT
Data sharing is not applicable to this article as no new data were created or analyzed in this study.
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