Prolonged carboxyhemoglobin clearance in a patient with Waldenström's macroglobulinemia

The case of a patient with elevated carboxyhemoglobin saturation, prolonged carboxyhemoglobin half-life, and Waldenström's macroglobulinemia is presented. In vitro studies on the patient's blood showed that the half-life of carboxyhemoglobin in the macroglobulinemic blood was about three times longer than in a normal blood sample. Similar experiments using normal and macroglobulinemic blood samples were done in which the macroglobulinemic plasma was replaced by normal saline, and there was no difference in the half-lives. Therefore, we believe the plasma phase played a significant role as a barrier to carbon monoxide transfer in this patient. The mechanism of this impairment is unclear at this time. Nonetheless, impaired carbon monoxide transfer in plasma has not been noted before and potentially has both diagnostic and therapeutic implications.