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Updated: Feb 28, 2026

Measurement of Heme Synthesis Levels in Mammalian Cells
Published on: July 9, 2015
Sulfhaemoglobinaemia caused by ferrous sulfate
Laith Derbas1, Mohamed Warsame1, Mohannad Abu Omar2
1Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas City, Missouri, USA.
Abstract:
A 78-year-old man was referred from his primary care clinic to the emergency department due to bluish discolouration of his lips and decreased oxygen saturation on pulse oximetry. The patient was asymptomatic. Physical exam was normal except for lip cyanosis. A CT pulmonary angiogram was negative for pulmonary embolism. Arterial blood gas (ABG) analysis with co-oximetry showed low oxyhaemoglobin, normal partial pressure of oxygen and methaemoglobinaemia, but an unexplained 'gap' in total haemoglobin saturation. This gap was felt to be due to sulfhaemoglobinaemia. After a thorough review of his medications, ferrous sulfate was stopped which resulted in resolution in patient's cyanosis and normalisation of his ABG after 7 weeks.
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