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Transport of gases

by the blood

Dra. Ma. Elena Torres Zazueta


mzazueta@uag.mx
Universidad Autónoma de Guadalajara, A.C. © , 2014,
2013 2015
General Objectives
• Define: percent hemoglobin saturation, oxygen tension, oxygen
content as they pertain to blood and be able to make calculations.
• Explain the exchange of oxygen between the alveolar air and
pulmonary capillary blood, and between the systemic capillary blood
and the tissues
• Discuss the transport of O2 by the blood
• Interpret the O2-Hb dissociation curve and explain the relationships
between oxygen partial pressure, hemoglobin saturation, and blood
oxygen content.
• Discuss factors that affect O2-Hb dissociation curve.

Universidad Autónoma de Guadalajara, A.C. © , 2014,


2013 2015
Terminology related to Oxygen transport

• Oxygen partial pressure


• Oxygen capacity vol%
• Oxygen saturation of Hb
• Oxygen content
• P50

Universidad Autónoma de Guadalajara, A.C. © , 2014,


2013 2015
Oxygen transport

• Dissolved O2
– Is proportional to the partial pressure

• In combination with hemoglobin

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2013 2015
Universidad Autónoma de Guadalajara, A.C. © , 2013
Oxygen Transport in Dissolved Form

• The amount of O2 in dissolved form obeys Henry’s


law
CO2 = O2 PO2
O2 = solubility coefficient of O2 in blood.
O2 = 0.003 ml O2/100 ml blood/mmHg.

• Normal arterial blood with PO2 of 100 mmHg


contains ONLY 0.3 ml O2/100 ml of blood.

Universidad
UniversidadAutónoma
Autónomade
deGuadalajara,
Guadalajara,A.C.
A.C.©©,,2013
2014,
2015
Oxygen transport
• Oxygen carrying capacity
– Maximum amount of O2 that can be combined
with Hb
• 1gm of pure Hb combine with 1.39 ml O2
• Hb is not 100% pure then:
1 gm of Hb combine with about 1.34 ml O2

15 gm of Hb x 1.34 ml O2 = 20.1 ml O2/ml of blood

Universidad Autónoma de Guadalajara, A.C. © , 2013


Universidad Autónoma de Guadalajara, A.C. © , 2014, 2015
Transport of oxygen
• Oxygen saturation
– Percentaje of Hb binding sites that have O2 attached

O2 combined with Hb X 100


O2 capacity

Arterial blood PO2 = 100 = Sat 97.5%


Venous mixed blood PO2 = 40 = Sat 75%
Universidad Autónoma
Universidad Autónoma de
de Guadalajara,
Guadalajara, A.C.
A.C. ©
© ,, 2014,
2013 2015
Arterial and Venous O2 Content
Attached to Hb dissolved

Universidad Autónoma de Guadalajara, A.C. © , 2014,


2013 2015
Objectives
• Draw and label an oxyhemoglobin dissociation curve
(hemoglobin oxygen equilibrium curve), showing the
amount of dissolved oxygen and the relationships
between oxygen partial pressure, hemoglobin
saturation, and blood oxygen content.
• How does the shape of the oxyhemoglobin
dissociation curve influence the uptake and delivery
of oxygen?
• Define P50.
• Show how the oxyhemoglobin dissociation curve is
affected by changes in blood temperature, pH,
PCO2, and 2,3-DPG.
Universidad Autónoma de Guadalajara, A.C. © , 2014,
2013 2015
Oxygen dissociation curve

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Oxygen dissociation curve

P50
PO2 when
50% of
Hemoglobin
is saturated

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Universidad Autónoma de Guadalajara, A.C. © , 2014, 2015
O2-Hb
Dissociation
curve Shift to
the right

• Increase in
temperature
• Increase in CO2
• Decrease in pH
• Increase in 2,3-DPG

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Universidad Autónoma de Guadalajara, A.C. © , 2014, 2015
Factors Influencing Hemoglobin Saturation

Increased temperature and 2,3-


DPG reduces O2 affinity.
Hydrogen Ion:
Increased H+ (↓ pH)
↑ H+ binding to Hb and
↓ O2 affinity
(HbO2+ H+  HbH+ +O2).

Carbon Dioxide (Bohr’s effect):


Increased PCO2,
↑ CO2 binding to Hb and
↓ O2 affinity (↑ O2 delivery to
tissue).

Universidad Autónoma de Guadalajara, A.C. © , 2013


Universidad Autónoma de Guadalajara, A.C. © , 2014, 2015
Universidad Autónoma de Guadalajara, A.C. © , 2013
Universidad Autónoma de Guadalajara, A.C. © , 2014, 2015
• Sigmoidal curve because of Cooperativity among
the 4 O2 binding sites.
• At low PO2, low affinity, small increase in binding
• At moderate PO2 values, increased PO2 , the
amount of bound O2 increases more steeply with
increases in PO2. So the affinity increases.
• At high PO2 the curve flattens as Hb saturates
Universidad Autónoma de Guadalajara, A.C. © , 2014,
2013 2015
Objectives
• List the forms in which carbon dioxide is carried
in the blood. Identify the percentage of total
CO2 transported as each form.
• Describe the importance of the chloride shift in
the transport of CO2 by the blood.
• Identify the enzyme that is essential to normal
carbon dioxide transport by the blood.
• Draw the carbon dioxide dissociation curves for
oxy and deoxyhemoglobin. Define the interplay
between CO2 and O2 binding on hemoglobin
that causes the Haldane effect.

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Carbon Dioxide Transport
• Physically dissolved
0.0006 ml CO2/mmHg PCO2 / 1 ml plasma = 2.4 ml CO2

• CO2 as Bicarbonate Ions (HCO3-):


Amount of CO2 stored as HCO3- at PCO2= 40 mmHg is about
42 ml/dl (90 % of the total arterial CO2).
80-90% is carried as bicarbonate ions

• Protein-bound CO2 (carbomino compunds):


R–NH2 + CO2  R–NH–COO– + H+.
Amount of CO2 stored as carbamino compounds is
about 2.1 ml/dl (4% of the total arterial CO2).
Universidad Autónoma de Guadalajara, A.C. © , 2013
Universidad Autónoma de Guadalajara, A.C. © , 2014, 2015
CO2 dissociation curve

As the % of HbO2
saturation
decreases, the
CO2 concentration
for a given PCO2
increases

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Universidad Autónoma de Guadalajara, A.C. © , 2013
Universidad Autónoma de Guadalajara, A.C. © , 2014, 2015
Transport and Exchange of CO2

• At the tissues:
– Bicarbonate quickly diffuses from RBCs into the plasma
– Chloride shift – to counterbalance the outrush of
negative bicarbonate ions from the RBCs, chloride ions
(Cl–) move from the plasma into the erythrocytes
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Universidad Autónoma de Guadalajara, A.C. © , 2014, 2015
Transport and Exchange of Carbon Dioxide
Tissue level

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2013 2015
Transport and Exchange of Carbon Dioxide
Lung level

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2013 2015
Haldane and Bohr Effect
• The amount of carbon dioxide transported is
markedly affected by the Po2

• Haldane effect – At lung level, binding of O2 with


the hemoglobin displace CO2 from the blood.

• Bohr effect - At the tissues, as more carbon


dioxide enters the blood:
– More oxygen dissociates from hemoglobin
– More carbon dioxide combines with hemoglobin, and
more bicarbonate ions are formed

Universidad Autónoma de Guadalajara, A.C. © , 2013


Universidad Autónoma de Guadalajara, A.C. © , 2014, 2015
Physiological and clinical
importance of PaCO2

• Must be measured to asses ventilation


• Abnormal levels are clear danger signal
• Never wait for cyanosis to correct ventilation
• PaCO2 Influences ventilation, oxygenation
and acid-base status
• Sedatives alter the CO2 response curves
(PCO2 causes less stimulation of ventilation)

Universidad Autónoma de Guadalajara, A.C. © , 2014,


2013 2015
Objectives
• Mechanisms of hypoxia
• Describe how anemia and carbon
monoxide poisoning affect the shape of
the oxyhemoglobin dissociation curve,
Pao2, Pco2, and Sao2.

Universidad Autónoma de Guadalajara, A.C. © , 2014,


2013 2015
Mechanism of hypoxia
1.Hypoxic
– E.g. high altitude
– Carotid bodies are stimulated by the low PO2, and
ventilation increases, then the PCO2 is below normal
2. Anemic
– True anemia: low oxygenation due to low hemoglobin
– Relative anemia: low oxygenation due to CO intoxication
3.Stagnant (hypoperfusion hypoxia)
– e.g. chronic heart failure
– Increased difference in the a-v content
4.Histotoxic
– Cyanide poisoning (CN) metabolic inhibitor that blocks
oxidative phosphorilation
Universidad Autónoma de Guadalajara, A.C. © , 2013
Universidad Autónoma de Guadalajara, A.C. © , 2014, 2015
Mechanism of hypoxia
1. Hypoxic hipoxia
– E.g. high altitude
– Carotid bodies are stimulated by the low PO2,
and ventilation increases, then the PCO2 is
below normal
VCO2
PACO2 =
VA
PB= 447
PaCO2= 30

PAO2 = 447- 47 x 0.21 – 30 = 46.5


0.8
Universidad Autónoma de Guadalajara, A.C. © , 2014,
2013 2015
Mechanism of hypoxia
2. Anemic hipoxia
– True anemia: low oxygenation due to low
hemoglobin

PAO2 = 760- 47 x 0.21 – 40 = 100


0.8
CaO2 = 10 x 1.39 x .97 + 0.003 x 100 = 13.78

Universidad Autónoma de Guadalajara, A.C. © , 2014,


2013 2015
Mechanism of hypoxia
2. Anemic hypoxia
– Relative anemia:
Low oxygenation due to CO intoxication

PAO2 = 760- 47 x 0.21 – 40 = 100


0.8

CaO2 = 15 x 1.39 x .60 + 0.003 x 100 = 12.81

Universidad Autónoma de Guadalajara, A.C. © , 2013


Universidad Autónoma de Guadalajara, A.C. © , 2014, 2015
Anemia CO

O2 Capacity Hb concentration x 1.34

O2 combined with
SaO2 Hb O2 capacity X 100

CaO2 O2 capacity x SaO2% +αO2xPaO2

PaO2 PB - PvH2O x FO2 – PCO2


R

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Universidad Autónoma de Guadalajara, A.C. © , 2014, 2015
Mechanism of hypoxia
3. Stagnant (hypoperfusion hypoxia)
– e.g. chronic heart failure
– Increased difference in the a-v content

Low CO

19.5 vol% 11.0 vol %

Normal a-v O2 difference = 5 vol %


Universidad Autónoma de Guadalajara, A.C. © , 2013
Universidad Autónoma de Guadalajara, A.C. © , 2014, 2015
Mechanism of hypoxia
4. Histotoxic hipoxia
– Cyanide poisoning (CN) metabolic inhibitor
that blocks oxidative phosphorilation

19.5 vol% 18.0 vol %

Universidad Autónoma de Guadalajara, A.C. © , 2013


Universidad Autónoma de Guadalajara, A.C. © , 2014, 2015
From Pulmonary Physiology 6th E Michael Levitzky

Universidad Autónoma de Guadalajara, A.C. © , 2014,


2013 2015
Summary
 Terminology related to Oxygen transport
 Oxygen transport

 Arterial and Venous O2 Content


 Oxyhemoglobin dissociation curve

 Factors Influencing Hemoglobin Saturation

 Carbon Dioxide Transport


 CO2 dissociation curve
 Mechanism of hypoxia  Hypoxic hypoxia
 Anemic hypoxia
 Hystotoxic hypoxia
Universidad Autónoma de Guadalajara, A.C. © , 2013
 Stagnant hypoxia
Universidad Autónoma de Guadalajara, A.C. © , 2014, 2015