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Pulse oximetry and factors associated with hemoglobin oxygen desaturation
in children with sickle cell disease
WR Rackoff, N Kunkel, JH Silber, T Asakura and K Ohene-Frempong
Division of Hematology, Children's Hospital of Philadelphia.
The observation of low transcutaneous arterial oxygen saturation (SaO2) in
otherwise well sickle cell patients has lead to questions about the
interpretation of pulse oximetry values in these patients. We undertook a
prospective study of children with sickle cell disease to (1) determine the
prevalence of, and factors associated with, low transcutaneous SaO2 in
clinically well patients, (2) develop an algorithm for the use of pulse
oximetry in acutely ill patients, and (3) assess the accuracy of pulse
oximetry in these patients. Eighty-six clinically well children with
hemoglobin (Hb) SS had a lower mean transcutaneous SaO2 than 22 Hb SC
patients and 10 control subjects (95.6% v 99.1% v 99.0%, respectively; p
< .001). In Hb SS patients, a history of acute chest syndrome and age
greater than 5 years were associated with lower transcutaneous SaO2 (mean
93.8% for those with a history of acute chest syndrome v 97.8% for those
without a history of acute chest syndrome, and 94.0% for patients > 5
years old v 97.2% for those < or = 5 years old; P < .001). These
associations were not seen in Hb SC patients. During acute illness, Hb SS
patients with acute chest syndrome had transcutaneous SaO2 values that were
less than 96% and at least 3 points lower than measurements made when they
were well. A nomogram was designed to aid in the interpretation of
transcutaneous SaO2 in acutely ill Hb SS patients when a comparison value
is not available. The accuracy of pulse oximetry was shown by the
correlation between SaO2 measured by pulse oximetry and calculated by using
the patient's oxygen dissociation curve and PaO2 (r = .97). This study
provides evidence that Hb oxygen desaturation is not a universal finding
among children with sickle cell disease and identifies factors associated
with Hb oxygen desaturation. We conclude that pulse oximetry may be useful
to assess whether progressive pulmonary dysfunction begins at an early age
in Hb SS patients, and to assess acutely ill patients for the presence of
hypoxemia associated with acute chest syndrome.
Volume 81,
Issue 12,
pp. 3422-3427,
06/15/1993
Copyright © 1993 by The American Society of Hematology
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