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Increased Oxygen Release in Hypoxemia and Heart Failure

Red cell 2,3-diphosphoglycerate (DGP), a primary regulator of oxygen-hemoglobin affinity, was measured in 55 infants and children with congenital cardiac diseases. The levels were compared with those from 20 normal patients and were analyzed with those from 20 normal patients and were analyzed with regard to patient age, arterial oxygen tension (PaO2), and the presence of heart failure. In 14 patients the oxygen dissociation from whole blood was also measured, and values for DPG were correlated with th ose for P 50, the PO2 for 50% oxygen saturation.Elevated levels of DPG were found in 17 of 18 infants and children with heart failure, regardless of age or PaO2.Thirty-seven patients had subnormal PaO2, but no heart failure. Among those >3 months of age, DPG was elevated in 26 of 28 with PaO2 = 16-56 mm Hg, and it was normal in 5 with PaO2 >56 mm Hg. In these 33 older patients, the level of DPG was inversely related to PaO2 ( r = −0.656). In four hypoxemic infants <3 months. DPG was normal.The close correlation found between elevated values for red cell 2,3-DPG and for whole blood P 50 (r = 0.7142) supports in vitro studies indicating that DPG is a primary regulator of oxygen release from human blood. The correlaion between levels of DPG and of PaO2 in patients > 3 months supports in vitro studies demonstrating deoxyhemoglobin control of red cell DPG synthesis. Among newborn infants the elevated levels of DPG measured in those with heart failure and the normal concentrations found in those with hypoxemia indicated two different control mechanisms for synthesis of this important modulator of oxygen homeostasis.