Oxygen Disosiation Curve

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The oxygen dissociation curve of adult
haemoglobin is a sigmoid curve. The three
main points to indicate on the curve are:
Arterial point: pO2 100 mmHg with SaO2 = 97.5%
Mixed venous: pO2 40 mmHg with SaO2 = 75%
P50: pO2 26.6 mmHg with SaO2 = 50%
Four other simple points to remember to allow rapid and reasonably
accurate drawing of the ODC in a viva are:
pO2 0 mmHg, SO2 0% - the origin
pO2 10 mmHg, S02 10% - just easy to remember & helps get the
sigmoid shape.
pO2 60 mmHg, SO2 91% - the ICU point
pO2 150 mmHg, SO2 98.8% - shows flat upper part of ODC

The ICU point can be considered as the point on the curve that
separates the steep lower part from the flat upper part.

This is a bit artificial but a pO2 of 60 mmHg in this sense is
considered as the lowest acceptable pO2 in an ICU patient because
marked desaturation occurs at pO2 values below this point.
What is the mixed venous point?

This is the point which represents mixed venous blood. The pO2
here is 40 mmHg and the haemoglobin saturation is 75%.
The oxygen content cannot be specified without further
information (eg [Hb] )

Note that the mixed venous point does NOT really lie on the normal
ODC as above (& in all the texts).
The increased pCO2 and decreased pH in mixed venous blood mean
that the mixed venous point must lie on a slightly right shifted ODC
rather than the standard ODC.

This is the Bohr effect.
What is meant by the term P50?
This term is used in reference to the oxygen dissociation
curve. It is defined as the partial pressure of oxygen at
which the oxygen carrying protein is 50% saturated.

It is usually used in relation to haemoglobin but can also be
used for other oxygen binding proteins such as myoglobin.

Though often drawn as a point on the dissociation curve,
this is incorrect as the P50 is, by definition, a point on the x-
axis as it is a particular pO2 value (& not a pO2-SO2 value
pair like the mixed venous point for example.)
What is the normal value for the P50 of adult
haemoglobin?
The P50 of normal adult haemoglobin is 26.6
mmHg.
What is the P50 used for?
Why was this point on the curve chosen for this purpose?

The P50 is used to specify the position of the oxygen dissociation
curve (or alternatively, the P50 is an index of oxygen affinity of the
oxygen carrying protein.
This is what specifying the position of the curve is really about).

It is the most useful point for specifying the curves position
because it is on the steepest part of the curve.
It is therefore the most sensitive point for detecting a shift of the
curve.
Specifying the P50 of a curve allows comparison with the position
of other curves under different conditions.
What does a right shift indicate?
What are the causes of a right shift?
A right shift indicates decreased oxygen affinity.
The P50 is higher for a right shifted curve.
A right shift can be caused by an increase in 4
factors:
temperature
[H+]
pCO2
red cell 2,3 DPG level.
Efek Bohr
Efek Bohr pertama kali dijabarkan oleh ilmuwan
Denmark bernama Christian Bohr.
Beliau menyatakan bahwa peningkatan konsentrasi
proton dan/atau CO
2
akan menurunkan daya serap
hemoglobin terhadap oksigen.
Peningkatan rasio plasma CO
2
juga akan menurunkan
pH darah oleh karena sifat antagonis antara proton dan
karbondioksida.
Peningkatan CO
2
ini akan mempengaruhi kurva oksigen
terlarut dalam darah. Pergeseran kurva ke sebelah
kanan berarti suatu pengurangan dalam afinitas dari
hemoglobin untuk oksigen.

Efek fasilitas transport oksigen seperti hemoglobin membungkus
oksigen di dalam paru-paru, tetapi kemudian melepaskan ke
jaringan-jaringan yang paling membutuhkan oksigen.
Ketika jaringan tersebut metabolismnya meningkat, produksi
karbon dioksidanya pun meningkat.
Karbon dioksida dengan cepat dijadikan molekul bikarbonat dan
proton asam oleh enzim karbonik anhydrase.
Hal ini menyebabkan pH jaringan menurun dan juga meningkatkan
oksigen terlarut dari hemoglobin, memperbolehkan jaringan
tersebut memperoleh oksigen yang cukup sesuai kebutuhannya.

Kurva disosiasi bergeser ke kanan ketika karbon dioksida atau
konsentrasi ion hydrogen meningkat.

The Bohr Effect
The Bohr effect was first discovered by a guy
named Christian Bohr.
He discovered that there were other factors that
affected the loading/unloading of oxygen by Hb.
One of the factors that he discovered was pH.
He found that if the pH was lower than normal
(normal physiological pH is 7.4), then Hb does not
bind oxygen as well.
This is shown in the following % Saturation graph.
This plot includes the % Saturation of Hb at normal pH
(7.4) and at a lower pH value (7.2).
You should notice that the curves are not identical
suggesting that pH affects the binding of oxygen to Hb.
Let us examine the % saturation at the lungs and at the
tissues when only the pH is changed.
In the lungs (pO
2
= 100 mm Hg), Hb is 98% saturated at
both pH 7.4 and 7.2.
Thus the binding of oxygen to Hb in the lungs is not
affected by changing the pH and oxygen will load
normally.
The situation is different at the tissues.
The change in the pH results is a lower % saturation of Hb even
though the pO
2
in the tissues has remained at 40 mm Hg for this
example.
Reading from the graph, the % saturation at pH 7.4 with a pO
2
of 40
mm Hg is about 70% (meaning 30% of the oxygen coming to the
tissue is released).
At a pH of 7.2, the value is close to 60% (meaning 40% of the
oxygen coming to the tissue is released).

Thus more oxygen is delivered to tissues at a lower pH even when the
pO
2
remains unchanged.
Lowering the pH appears to shift the entire red curve to the right.

Another indicator that a tissue has a high
metabolic rate (and thus a need for increased
oxygen delivery) is the production of carbon
dioxide.
When a tissue is more active, the amount of
carbon dioxide produced will be increased
(pCO
2
is higher).
Carbon dioxide reacts with water as shown in the
following equation:

CO
2
+ H
2
O <---------> H
+
+ HCO
-
3


What this means is that as the amount of carbon dioxide increases,
more H
+
are formed and the pH will decrease.
Thus, a lower pH in the blood is suggestive of an increased carbon
dioxide concentration which in turn is suggestive of a more active
tissue that requires more oxygen.

According to Bohr, the lower pH will cause Hb to deliver more
oxygen.

Note that if pO
2
and pH should drop together, even more oxygen
will be delivered then if only one of the parameters were changed
(for example, pH = 7.2, pO
2
= 30 mm Hg compared to pH = 7.4,
pO
2
= 30 mm Hg).