Reza

Two traps in one case.

So here's what I would propose to you.

And what I'd love, Prof. Rez, because actually my confidence level is not perfect, but I'd love for you to actually be a judge and criticize the proposal I'm going to share with you about what holes it is.

But here's what I think is going on.

this patient came in, was fine, but was diagnosed with acute leukemia.

And then he got raspberry case and raspberry case likely induced a methemoglobinemia in him.

And it's a classic case of that right now, because we look and we see his SAT is 80%, yet his PAO2 is 400.

But we have to acknowledge that

that there's one other gap in addition to the gap between the PaO2 of 400 and the SAT of 80%, which is that the other PaO2 that we got was 51.

Why is there a difference between those two?

So if you're following me, I'm using a horizontal table of the difference between the PaO2 at bedside and the SAT at bedside.

And there's a big difference between the PaO2 of 400 at the bedside and the SAD of 80% at the bedside.

That is a virtually diagnostic of a disordered hemoglobin molecule, usually methemoglobinemia, sometimes other ones like self-hemoglobin.

So that is 99.9% chance.

But what about the difference between the PaO2 at bedside and the PaO2 in the lab and the ABG that Dan very, very quickly, but shrewdly said was sent downstairs to the lab?

Why is there a difference?

That difference is because of the hypercellularity of the leukemic cells that ate up all that oxygen well before it went down the lab.

This is a double trap, Prof. Rez.

This is the leukemic cells eating up the PaO2 before they get to the lab and the raspberry case

I was saying methemoglobinemia.