A 25-year-old Caucasian man with a history of spherocytosis, splenectomy, recurrent blood transfusion, and no cardiopulmonary disease presented for an emergent laparoscopic cholecystectomy with a baseline pulse oximetric saturation (SpO2) of 88% while breathing room air. The SpO2 increased to only 89% during preoxygenation with an FIO2 1.0. Multiple arterial blood samples revealed SaO2 as high as 100% with PaO2 averaging 390 mm Hg. He was subsequently diagnosed with a dyshemoglobin, hemoglobin Köln. The simultaneous presentation of a stable patient from a cardiopulmonary perspective with normal arterial oxygen tension and saturation in the blood gas analyses despite a low SpO2 measurement outlines the importance of integrating the history of present illness and both the importance and the limitation of the pulse oximetry.
From the University Heart Center Freiburg, Freiburg, Germany.
Stefan Brugger, MD, and Maria-Dolores Santafé-Marti, MD, are currently with Freiburg, Germany, DRK Freiburg.
Malika Lakhal, MD, is currently with Dachsberg-Finsterlingen, Germany, DRK Freiburg.
Accepted for publication March 23, 2017.
The authors declare no conflicts of interest.
Address correspondence to Stefan Brugger, MD, Eschbachweg 8A, D-79117 Freiburg, Germany. Address e-mail to firstname.lastname@example.org.