Presence Of Carboxyhemoglobin Research Articles

Analysis of injuries in aircraft accident victims in 2002–2022 based on the resources of the Jagiellonian University Department of Forensic Medicine in Kraków = Analiza obrażeń ofiar katastrof lotniczych w latach 2002–2022 na podstawie danych pochodzących z materiałów Zakładu Medycyny Sądowej Uniwersytetu Jagiellońskiego w Krakowie

Aim: The study aimed to analyse the most common injuries of victims of aviation accidents and compare it with the most recent literature. Methods and materials: Retrospective analysis of autopsy protocols of aircraft crash victims from the Forensic Medicine Department from years 2002–2022. The case selection has been made by two independent researchers. After applying the exclusion criteria 27 cases were obtained. Further searched for features that the bodies of victims had in common. There were analysed sex, age, circumstances of the incident, injuries, presence of psychoactive substances (alcohol, drugs), and blood concentration of carboxyhemoglobin. Results: Among 27 cases we found 19 airplane crashes, 4 glider accidents, 3 motor glider accidents, and one helicopter crash. The 1 case had no information about the type of aircraft. The injuries that emerged in each of the victims were typical results of direct impact forces. The most common were rupture of the lungs 63.0 % (n = 17/27), heart 55.6% (n = 15/27), liver 51.9% (n = 14/27), aorta 40.7% (n = 11/27) and spleen 29.6% (n = 8/27). Common bone traumas included fractures of the ribs 77.8% (n = 21/27) upper limbs 77.8% (n = 21/27), skull 74.1% (n = 20/27), pelvis 59.3% (n = 16/27) and spine 51.9% (n = 14/27). Injuries of the cervical spine occurred in victims who violently tilted their heads back. Conclusions: In most cases, the immediate cause of death was extensive multi-organ injuries, followed by thermal burns or brain injuries. In almost half of the victims, the presence of carboxyhemoglobin in the blood indicates that they were alive during the crashes. Knowledge of injury patterns can improve aviation safety and guide in reconstructing the mechanisms and sequences of the accidents.

Investigating the color of the blood stains on archaeological cloths: the case of the Shroud of Turin.

The unique reddish blood stains on the archaeological cloth known as the Shroud of Turin caught the attention of several scholars, who proposed different hypotheses to explain the unusual blood color. To date, just a few hypotheses have been tested experimentally, and the results are debatable. In this paper, we test the strength of two hypotheses (namely, the presence of carboxyhemoglobin and the long-term influence of ultraviolet light on high-bilirubin blood) by the spectral reflectance of the blood stained regions on the Shroud and by color analyses of ultraviolet irradiated high-bilirubin blood stains on linen. The relevance of these simple methods to the study of stained textiles is discussed.

Concepts of Arterial Oxygen Saturation in the Presence of Carboxyhemoglobin

Concepts of Arterial Oxygen Saturation in the Presence of Carboxyhemoglobin

Reply: Concepts of Arterial Oxygen Saturation in the Presence of Carboxyhemoglobin

Reply: Concepts of Arterial Oxygen Saturation in the Presence of Carboxyhemoglobin

In Vitro Absorption of Atmospheric Carbon Monoxide and Hydrogen Cyanide in Undisturbed Pooled Blood

Blood samples from aircraft accident victims are analyzed for carboxyhemoglobin (COHb) and cyanide ion (CN(-)). Such victims often suffer open wounds near the autopsy blood collection sites. Many aircraft crashes result in fires that fill the victim's atmosphere with smoke that is rich in carbon monoxide (CO) and hydrogen cyanide (HCN). It is important to determine whether pooled blood in those wounds may have absorbed these gases after death, which could lead one to erroneously conclude that the presence of COHb and CN(-) in blood was the result of breathing in these gases. A laboratory desiccator was used as a chamber to establish whether CO or HCN may be absorbed in undisturbed, pooled blood. COHb levels were 4.3-11.0% after exposure to CO (5,532, 8,298, 11,064, 22,129 and 33,193 ppm) for 30 and 60 min. Blood CN(-) concentrations (1.43-5.01 µg/mL) increased with exposure to HCN at 100 and 200 ppm, each at 15, 30, 45 and 60 min. The observed COHb increases do not exclude the possibility for higher COHb levels in blood exposed to highly CO-rich atmospheres, but there is a strong potential for CN(-) levels to increase by the absorption of atmospheric HCN. Thus, postmortem COHb and CN(-) levels should be carefully interpreted.

Impact de l'anémie sur les traitements des cancers du col utérin

During the treatments of carcinomas of the cervix, anemia is relatively frequent and its origin is complex combining often hemorrhage, iron deprivation, inflammatory reactions and infection. The frequency of the primary anemia (hemoglobin level<12 g/dl) is correlated with clinical stage and varies from one publication to another, mainly from 25% for stage I, to 33% for stage II and can approach 40% for stage III. Anemia is correlated with patient survival and it appears to be one of the most powerful prognostic factor after clinical stage and tumor size. Anemia is a bad prognostic factor related to stage and tumor size but it has not been proven to be an independent factor. Anemia increases hypoxia of cervix carcinomas, which is an independent prognostic factor for patients N0. Moreover, we know that the oxygenation of these tumors is correlated with hemoglobin levels. The normalization of Hb levels by transfusion could certainly modify the prognosis of patients anemic before treatment, or of those becoming anemic during radiotherapy treatment. For smokers, anemia is certainly more important that we can appreciate from the Hb levels only, by the presence of carboxyhemoglobin. Concomitant chemotherapies with cisplatin compounds are actually standards and they can largely increase the risk of inducing anemia, therefore more than 50% of patients will experiment it during their different treatments. Transfusion is recommended by the SOR (Standards Options and Recommendations of the Fédération nationale des centres de lutte contre le cancer) under 10 g/dl. The use of erythropoietin is a therapeutic option for Hb levels between 10 and 12 g/dl and strongly recommended after a Hb normalization by blood transfusion. For 70% of patients who respond to erythropoietin, a better control of the Hb level is obtained. The impact of this anemia on quality of life and treatments compliance justifies the use of erythropoietin, especially in cancers for which treatments induce a deep fatigue and a very bad tolerance, which could be a limiting factor.

Evidence that haem iron in the malaria parasite is not needed for the antimalarial effects of artemisinin

The role of haem iron (II) and oxidative stress in the activation and antimalarial activity of artemisinin is unclear. Thus, we submitted malaria parasite to modified culture conditions: artemisinin activity increased by 20–30% under an oxygen-rich atmosphere (20% O 2 instead of “standard” 1% O 2), and by 40–50% in the presence of carboxy-haemoglobin, and 2% carbon monoxide, conditions which inhibit haem iron (II) reactivity. In all cases, parasite growth and chloroquine activity were unaffected. We conclude that in the malaria parasite artemisinin is not activated by haem iron and that free radicals are not needed for its toxicity.

Gunshot injuries as a topic of medicolegal research in the German-speaking countries from the beginning of the 20th century up to the present time

The 100th anniversary of the foundation of the German Society of Legal Medicine is a good opportunity to review its contributions to forensic wound ballistics. The present article gives an overview of the scientific development in this field with special emphasis on work pioneering new developments and findings valid up to the present day, for example the presence of carboxyhemoglobin in the vicinity of the entrance wound as a sign of a contact or close-range shot [A. Paltauf, Wien. Klin. Wochenschr. 3 (1890) 984–991, 1015–1017]; the correct interpretation of the muzzle imprint [A. Werkgartner, Beitr. Gerichtl. Med. 6 (1924) 148–161] and the retrograde ballooning of the bullet entrance region in contact shots [F. Hausbrandt, Dtsch. Z. ges. Gerichtl. Med. 38 (1944) 45–76; H. Elbel, Med. Welt 20 (1958) 343–345]; wound patterns from captive-bolt livestock stunners [H. Czursiedel, Dtsch. Z. ges. Gerichtl. Med. 28 (1937) 132–133]; singeing of synthetic fiber textiles in close-range shots with nitro powder ammunition [S. Berg, Arch. Kriminol. 124 (1959) 5–8,17–22]; the wound ballistic processes on penetration of the bullet and the origin of the abrasion collar [K. Sellier, Beitr. Gerichtl. Med. 25 (1969) 265–270]. More recently medicolegal research in the German-speaking countries covered the following subjects: studies of the dynamic bullet-target interactions in experimental gunshots to simulants and composite body models; use of modern imaging techniques (CT, MRI) in the pre-autopsy diagnosis of lethal gunshot injuries; injuries from blank guns; mechanisms of incapacitation by gunshot injuries; development of improved methods for the evidence of gunshot residues on the firing hand; backspatter from close-range shots; medicolegal contributions in the discrimination of accidental, homicidal and suicidal gunshot injuries.

Non-invasive measurement of carboxyhemoglobin (COHb) by new pulse oximeter in human volunteers

Carbon monoxide is the most commonly encountered and pervasive poison in our environment. However, conventional pulse oximeters cannot detect the presence of carboxyhemoglobin (COHb) and overestimate arterial oxygenation in patients with severe carbon monoxide poisoning. We developed a new pulse oximeter utilizing three wavelengths which can discriminate three species, oxyhemoglobin (O2Hb), deoxyhemoglobin (RHb) and COHb. We previously demonstrated that increases in COHb concentration measured by the new pulse oximeter (SpCO) highly correlated with increases in COHb concentration measured by a CO-oximeter (SaCO) in pigs. The present study determined whether COHb was detected by the pulse oximeter with three wavelengths in human.

Observed versus predicted carboxyhemoglobin levels in cellulose triacetate workers exposed to methylene chloride.

Occupational exposure to methylene chloride, together with carboxyhemoglobin concentrations, has not been studied previously. Carboxyhemoglobin levels were measured in non-smoking employees exposed to varying concentrations of methylene chloride during the manufacture of cellulose triacetate fibers. The observed carboxyhemoglobin levels were compared to predicted concentrations using a pharmacokinetic model. The presence of carboxyhemoglobin in non-smokers exposed to methylene chloride results primarily from the metabolism of methylene chloride in the liver and exhibits a linear dose-response relationship. The observed levels of carboxyhemoglobin in non-smokers at the end of an 8-hour shift depend upon exposures to methylene chloride that day but are independent of occupational exposures on previous days. The observed daily concentrations of carboxyhemoglobin are consistent with predicted concentrations using a pharmacokinetic model. While varying exposure patterns were shown to change the rate of metabolite formation at the end of shift, these same exposure patterns had almost no effect on the total amount of carbon monoxide in the blood. While the present study addresses the relationship between methylene chloride, carbon monoxide, carboxyhemoglobin and ischemic heart disease, it does not address the issue of tumorigenicity, which is also the basis for the current U.S. Occupational Health and Safety workplace exposure limit of 25 ppm. This study provides support for the conclusion that the current American Conference of Governmental Industrial Hygienists 8-hour Threshold Limit Value of 50 ppm adequately protects human health with regard to ischemic heart disease and carboxyhemoglobin formation among non-smokers.

Protective effect of stroma-free methemoglobin during cyanide poisoning in dogs.

During fire exposure, cyanide toxicity can block aerobic metabolism. Oxygen and sodium thiosulfate are accepted therapy. However, nitrite-induced methemoglobinemia, which avidly binds cyanide, decreases oxygen-carrying capacity that is already reduced by the presence of carboxyhemoglobin (inhalation of carbon monoxide in smoke). This study tested whether exogenous stroma-free methemoglobin (SFmetHb) can prevent depression of hemodynamics and metabolism during canine cyanide poisoning. In 10 dogs (weighing 18.8 +/- 3.5 kg) anesthetized with chloralose-urethane and mechanically ventilated with air, baseline hemodynamic and metabolic measurements were made. Then, 137 +/- 31 ml of 12 g% SFmetHb was infused into five dogs (SFmetHb group). Finally, the SFmetHb group and the control group (n = 5, no SFmetHb) received an intravenous potassium cyanide infusion (0.072 mg.kg-1.min-1) for 20 min. Oxygen consumption (VO2) was measured with a Datex Deltatrac (Datex Instruments, Helsinki, Finland) metabolic monitor and cardiac output (QT) was measured by pulmonary artery thermodilution. From baseline to cyanide infusion in the control group, QT decreased significantly (p < 0.05) from 2.9 +/- 0.8 to 1.5 +/- 0.4 l/min, mixed venous PCO2 (PvCO2) tended to decrease from 35 +/- 4 to 23 +/- 2 mmHg, PvO2 increased from 43 +/- 4 to 62 +/- 8 mmHg, VO2 decreased from 93 +/- 8 to 64 +/- 19 ml/min, and lactate increased from 2.3 +/- 0.5 to 7.1 +/- 0.7 mM. In the SFmetHb group, cyanide infusion did not significantly change these variables. From baseline to infused cyanide, the increases in blood cyanide (4.8 +/- 1.0 to 452 +/- 97 microM) and plasma thiocyanate cyanide (18 +/- 5 to 65 +/- 22 microM) in the SFmetHb group were significantly greater than those increases in the control group. SFmetHb itself caused no physiologic changes, except small decreases in heart rate and PvO2. Peak SFmetHb reached 7.7 +/- 1.0% of total hemoglobin. Prophylactic intravenous SFmetHb preserved cardiovascular and metabolic function in dogs exposed to significant intravenous cyanide. Blood concentrations of cyanide, and its metabolite, thiocyanate, revealed that SFmetHb trapped significant cyanide in blood before tissue penetration.

Carbon Monoxide Poisoning: Some Surprising Aspects of the Equilibrium between Hemoglobin, Carbon Monoxide, and Oxygen

Carbon monoxide poisoning and some aspects of the equilibrium between carbon monoxide, oxygen, and hemoglobin are discussed within the framework of Haldane's laws. The effect of CO on respiration is analyzed quantitatively using oxygen dissociation curves of hemoglobin in presence of carboxyhemoglobin. The analysis shows that the adverse cardiovascular consequences of chronic CO exposure are unlikely to be due to reduced O2 transport capability of hemoglobin.

Rapid multicomponent analysis of hemoglobin derivatives for controlled antidotal use of methemoglobin-forming agents in cyanide poisoning

When cyanide poisoning is treated with a methemoglobin-forming agent, oxidative metabolism is protected at the expense of the oxygen capacity of the blood. The affinity of methemoglobin for CN- is high enough to compete with cytochrome oxidase, which protects the latter from becoming blocked, but all hemoglobin used for this purpose is lost for the transport of oxygen. Therefore, the fractions of the various hemoglobin derivatives present in the blood should be carefully monitored during this kind of treatment. After we had developed a multiwavelength spectrophotometric method for this purpose, we studied the feasibility of using a modified commercial six-wavelength hemoglobin photometer (Radiometer OSM3) for easy and rapid analysis of methemoglobin and methemoglobin cyanide in small samples of blood. All conditions appeared to be fulfilled for the construction of a practical multiwavelength photometer for reliably monitoring methemoglobin therapy in patients with cyanide poisoning, even in the presence of carboxyhemoglobin, as often occurs in fire victims.

The effect of dyshemoglobins on pulse oximetry: Part I, Theoretical approach and Part II, Experimental results using an in vitro test system.

Pulse oximeters are known to be inaccurate in the presence of elevated concentrations of carboxyhemoglobin and methemoglobin. This paper attempts to alleviate some of the confusion that exists between fractional and functional saturation, and to clarify the comparison of each with SpO2. A series of theoretical relationships between pulse oximeter reading (SpO2) and actual oxygen saturation (both fractional and functional) is derived using simple absorption theory. The theoretical relationships are checked using an experimental in vitro test system. This consists of a blood circuit containing a model finger, capable of simulating the pulsatile transmission signals through a real finger. Theoretical predictions and experimental results are compared and are found to agree well in the presence of carboxyhemoglobin, but less well with methemoglobin. Possible reasons are discussed.

Absorption spectra of human fetal and adult oxyhemoglobin, de-oxyhemoglobin, carboxyhemoglobin, and methemoglobin

We determined the millimolar absorptivities of the four clinically relevant derivatives of fetal and adult human hemoglobin in the visible and near-infrared spectral range (450-1000 nm). As expected, spectral absorption curves of similar shape were found, but the small differences between fetal and adult hemoglobin absorptivity were important enough that they should be taken into account in multicomponent analysis of hemoglobin derivatives. Common pulse oximeters, however, involving light of 660 and 940 nm, are so insensitive to the presence of fetal hemoglobin that they can be used safely in neonates. The error in pulse oximetry caused by the presence of carboxyhemoglobin is insubstantial, but methemoglobin gives either an understimation or an overestimation at high or low oxygen saturation, respectively, the turning point being near 70% saturation.

CARBOXYHAEMOGLOBIN CONCENTRATIONS, PULSE OXIMETRY AND ARTERIAL BLOOD-GAS TENSIONS DURING JET VENTILATION FOR Nd-YAG LASER BRONCHOSCOPY

Oxygen saturation measured with pulse oximetry (SpO2) is overestimated in the presence of carboxyhaemoglobin (COHb). Smoke produced during laser resection of tracheobronchial malignancies may increase concentrations of COHb. We have measured COHb concentrations in 14 patients undergoing laser resection and compared SpO2 with functional oxygen saturation (SaO2) to ascertain if pulse oximetry is an accurate monitor of oxygen saturation. During the procedure frequent changes occur in ventilatory mechanics. Arterial blood-gas tensions were measured to see if gas exchange was satisfactory. Mean preoperative COHb was 1.4%. There was no significant change in COHb in any patient at any stage during treatment. The highest value was 2.05%. The mean difference between SaO2 and SpO2 was 1.13% (95% confidence interval 0.70-1.56%). Oxygen saturation may therefore safely be monitored by pulse oximetry in patients managed by our technique. Empirical setting of a jet ventilator provided acceptable blood-gas tensions, although sometimes it was necessary to increase the FlO2 to greater than 0.3 to maintain oxygenation.

How Accurate Is Pulse Oximetry in Patients With Burn Injuries?

Pulse oximetry is a noninvasive method of measuring arterial oxygen saturation. The value of oximetry in patients with burn injuries has been questioned because of a theoretic inaccuracy in the presence of carboxyhemoglobin. We studied pulse oximetry in 27 intubated patients with burn injuries to determine the accuracy of the method and then to determine whether oximetry could replace indwelling catheters presently used for arterial blood gas analysis. Oximeter and arterial blood gas saturation data correlated closely, with a coefficient of 0.820. The pulse oximeter predicted "adequate" ventilation in 78% of patients with a readout of 99% or above. The arterial PO2 was greater than or equal to 90 torr in 90% of patients with oximetric readouts greater than or equal to 98% and in 10% of patients with readouts less than 95%. Pulse oximetry is an accurate adjunct in the management of patients with burn injuries and in addition provides continuous real-time data not available with arterial blood gas sampling.

The stability of several compounds in formalin fixed tissues and formalin-blood solutions

Buffered formalin solutions were added to spiked blood samples containing diazepam, phenytoin, carbon monoxide and cyanide to give formalin-whole blood solutions of 5 and 8%. Sections of liver positive for desipramine, phenobarbital and phenytoin were placed in separate 5 and 8% formalin-water solutions. The formalin-blood solutions were monitored daily for 30 days, while the fixed liver and formalin-water samples were analyzed once a week for 4 weeks. In the formalin-blood solutions losses were found for diazepam and phenytoin over the 30-day period of at least 41% and 33%, respectively. Cyanide detection was not possible immediately after the addition of formalin and the presence of carboxyhemoglobin was difficult to detect after 1 week. In the liver, losses of phenobarbital and desipramine were > 60% while phenytoin showed little change. This study has revealed that the drugs examined at toxic concentrations can be detected, with variable recoveries, for up to 30 days after fixation with formalin. However, quantitative analysis for cyanide and carboxyhemoglobin may be significantly impaired in the presence of formaldehyde.

The effect of carbon monoxide inhalation on pulse oximetry and transcutaneous PO2.

Five dogs were anesthetized, intubated, and ventilated with various mixtures of oxygen, nitrogen, and carbon monoxide. Each dog was monitored with arterial and pulmonary artery catheters, a transcutaneous PO2 analyzer, and two pulse oximeters. An IL-282 Co-oximeter was used to periodically measure arterial oxyhemoglobin (O2Hb) and carboxyhemoglobin (COHb) as percentages of the total hemoglobin. The PaO2, PaCO2, and pHa were measured in the same blood specimens using standard electrodes. When the inspired oxygen concentration was reduced in the absence of COHb, the pulse oximeter saturation (SpO2) estimated O2Hb with reasonable accuracy. COHb levels were then varied slowly from 0-75% in each dog. As the COHb level increased and oxyhemoglobin decreased, both pulse oximeters continued to read an oxygen saturation of greater than 90%, while the actual O2Hb fell below 30%. In the presence of COHb, the SpO2 is approximately the sum of COHb and O2Hb, and, thus, may seriously overestimate O2Hb. The pulse oximeter, as the sole indicator of blood oxygenation, should, therefore, be used with caution in patients with recent carbon monoxide exposure. On the other hand, transcutaneous PO2 falls linearly as COHb increases, and reaches about one-fifth of its initial value at the highest COHb levels despite the maintenance of constant arterial PO2.

Venous crossover PO2. A reference point for assessing the physiological significance of alterations in oxyhaemoglobin equilibrium.

A method is described for the quantitative analysis of the physiological significance of either an increase or decrease in P50. The venous crossover PO2 (PvxO2) refers to that PO2 of the mixed venous blood on the standard oxyhaemoglobin equilibrium (OHE) curve at which the extraction of oxygen from the blood is the same for both the standard and the in vivo arterial and venous OHE conditions. A measured PvO2 which is greater than the PvxO2 indicates that the in vivo OHE conditions conferred a benefit over the standard conditions inasmuch as the same volume of oxygen was delivered to the tissues at a higher venous PO2. The method of determining the venous crossover PO2 from the measured arteriovenous difference in haemoglobin saturation of oxygen is described using a mathematical model of the oxyhaemoglobin equilibrium curve. The presence of carboxyhaemoglobin is accounted for in this analysis. Clinical examples in which the method is applied are presented.