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    Hemoglobin derivatives

    Methemoglobin; Carboxyhemoglobin; Sulfhemoglobin

    Hemoglobin derivatives are altered forms of hemoglobin. Hemoglobin is a protein in red blood cells that moves oxygen and carbon dioxide between the lungs and body tissues.

    This article discusses the test used to detect and measure the amount of hemoglobin derivatives in your blood.

    The test is done using a small needle to collect a sample of blood from an artery. The sample may be collected from an artery in the wrist, groin, or arm.

    Before blood is drawn, the health care provider may test circulation to the hand (if the wrist is the site). After the blood is drawn, pressure applied to the puncture site for a few minutes stops the bleeding.

    No special preparation is needed.

    For children, it may help to explain how the test will feel and why it is done. This may make the child feel less nervous.

    You may feel slight pain or a sting when the needle is inserted. You may also feel some throbbing at the site after the blood is drawn.

    This test is used to diagnose carbon monoxide poisoning. It is also used to detect changes in hemoglobin that may result from certain drugs.Some chemicals or drugs can change the hemoglobin so it no longer works properly.

    Abnormal forms of hemoglobin include:

    • Carboxyhemoglobin. An abnormal form of hemoglobin that has attached to carbon monoxide instead of oxygen or carbon dioxide. High amounts of this type of abnormal hemoglobin prevent the normal movement of oxygen by the blood.
    • Sulfhemoglobin. A rare abnormal form of hemoglobin that cannot carry oxygen. It may result from certain medicines such as phenacetin or toxins such as nitrites or anilines.
    • Methemoglobin. A problem that occurs when the iron that is part of hemoglobin is changed so that it does not carry oxygen well. Certain drugs and other compounds introduced into the blood stream can cause this problem.

    The following values represent the percentage of hemoglobin derivatives based on total hemoglobin:

    • Carboxyhemoglobin: less than 1.5% (but may be as high as 9% in smokers)
    • Methemoglobin: less than 2%
    • Sulfhemoglobin: undetectable

    Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.

    The examples above show the common measurements for results for these tests. Some laboratories use different measurements or may test different specimens.

    High levels of hemoglobin derivatives can lead to significant health problems. The altered forms of hemoglobin do not allow oxygen to be moved properly through the body. This can lead to tissue death.

    The following values, except sulfhemoglobin, represent the percentage of hemoglobin derivatives based on total hemoglobin:

    Carboxyhemoglobin:

    • 10-20% symptoms of carbon monoxide poisoning begin to appear
    • 30% severe carbon monoxide poisoning present
    • 50-80% results in deadly carbon monoxide poisoning

    Methemoglobin:

    • 10-25% results in bluish skin color(cyanosis)
    • 35-40% results in shortness of breath and headache
    • Over 60% results in lethargy and stupor
    • Over 70% results in death

    Sulfhemoglobin:

    • Values of 10 grams per deciliter (g/dL) cause bluish skin color due to lack of oxygen (cyanosis), but do not cause harmful effects.

    References

    Benz EJ Jr, Ebert BL. Hemoglobin variants associated with hemolytic anemia, altered oxygen affinity, and methemoglobinemias. In: Hoffman R, Benz EJ Jr, Silberstein LE, Heslop HE, Weitz JI, Anastasi J, eds. Hoffman Hematology: Basic Principles and Practice. 6th ed. Philadelphia, Pa: Churchill Livingstone Elsevier; 2012:chap 41.

    Bunn HF. Approach to the anemias. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa.: Saunders Elsevier; 2011:chap 161.

    Christiani DC. Physical and chemical injuries of the lung. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa.: Saunders Elsevier; 2011:chap 94.

    Ford MD. Acute poisoning. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa.: Saunders Elsevier; 2011:chap 110.

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          Tests for Hemoglobin derivatives

          Review Date: 4/24/2013

          Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.

          The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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