Failure of Pulse Oximetry and Cooximetry as Monitors in a Patient With Hemoglobin MIwate: A Case Report

Abstract

We present the perioperative details of a 2-year-old child scheduled for cleft palate repair. Low pulse oximetry readings after induction of anesthesia and before surgery led to the diagnosis of HbMIwate, a rare congenital methemoglobinemia due to mutation in the α-globin gene. We explored the utility of noninvasive cooximetry to monitor methemoglobin and oxygenation during anesthesia and found that noninvasive cooximetry is not useful to monitor oxygenation or to detect the percentage of methemoglobin arising from congenital variants like HbMIwate.

Low oxygen saturation measured by pulse oximetry with a novel haemoglobin variant, Haemoglobin PKU

“…It can offer real-time assessment of oxygen status and has been used as a standard monitor during the peri-operative period. But unexpected low pulse oxygen saturations (SpO 2 ) have been reported in some patients with variant haemoglobins 1–3 . In this report, we describe a patient with a novel haemoglobin variant who had unexplained low pulse oximetry values before general anaesthesia.…”

“…But unexpected low pulse oxygen saturations (SpO 2 ) have been reported in some patients with variant haemoglobins. [1][2][3] In this report, we describe a patient with a novel haemoglobin variant who had unexplained low pulse oximetry values before general anaesthesia. Written informed consent was provided for publication of the case report.…”