Determining P50 in the presence of carboxyhemoglobin

A method is proposed, using mathematical solutions to the Roughton-Darling analysis, that theoretically can correct the measurements used for P50 determinations, whenever HbCO is present in blood, either initially or after equilibration. The resulting P50 is calculated in a "CO-free" state, independent of the actual presence of HbCO. This can be converted to a term designated T50, which indicates the in vivo shift caused by the concentration of HbCO measured. The concept was tested by comparing the P50 measurements in subjects with normal hemoglobins who differed by smoking habits (smokers vs. nonsmokers). The results showed similar mean values for this definition of P50, despite an average 10-fold difference in initial concentrations of HbCO. The method is applicable both to the single point principle, wherein P50 is estimated directly from venous blood measurements, and to standard tonometry-mixing techniques, as long as instrumentation includes the measurement of CO saturation.