This oxidized ferric iron bounds to hydroxyl group of water molecule in which this complex has a shift toward the left in
oxygen dissociation curve and is incapable to transport oxygen which leads to an ablated oxygenation in tissue with consequent hypoxic features.
A highaffinity hemoglobin variant will have a left-shifted
oxygen dissociation curve, reflecting the aberrant molecule's ability to bind oxygen at relatively low oxygen pressure.
The effect of blood transfusion on the haemoglobin
oxygen dissociation curve of very early preterm infants during the first week of life.
CO can displace oxygen and lead to the shifting of the
oxygen dissociation curve to the left.
Additionally, with the increased RBC 2,3-DPG the
oxygen dissociation curve shifts to the right indicating a facilitated release of oxygen to the muscles.
On this occassion I also would like to emphasize that methylenblue (1-2 mg/kg in 1% solution; in higher concentration and doses causes and or increases methemoglobinemia) should be preferred in acquired as well as hereditary enzymopenic methemoglobinemias, since it is effective within minutes with corrected
oxygen dissociation curve. It was also used orally (2-5 mg/kg/day) in our enzymopenic methemoglobinemia patients successfully.
A high [P.sub.50] indicates a rightward shift in the
oxygen dissociation curve, i.e., a low oxygen affinity.
The [So.sub.2], when measured by means of arterial blood-gas analysis, is calculated from the blood PH, the [Po.sub.2], and the standard Hb
oxygen dissociation curve. Unfortunately, this approach to calculating the (So.sub.2) assumes a normal
oxygen dissociation curve, and metHb can falsely elevate the calculated (So.sub.2).
In addition, the remaining [Fe.sup.2+] ferrous haems within the haemoglobin tetramer containing [Fe.sup.3+] ferric haems paradoxically exhibit increased oxygen affinity, causing the
oxygen dissociation curve to be shifted 'to the left', which further impairs oxygen delivery to the tissues (Fig.
This is known as cooperative binding, and is the reason for the sigmoid shape of the
oxygen dissociation curve. This also explains why hemoglobin is most attracted to oxygen when three of the four subunits are bound to oxygen.
However, 88% were not aware of the basic relationship between oxygen saturation and the partial pressure of oxygen in arterial blood (
oxygen dissociation curve).
Owing to the sigmoid shape of the
oxygen dissociation curve arterial oxygen saturation is an insensitive reflection of arterial oxygen tension.