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Abstract Background: There are some clinical conditions that can impact the accuracy of spO 2 measurements, leading to an incorrect diagnosis of hypoxemia. Low oxygen affinity hemoglobinopathy can present with low spO 2 and discordance with PaO 2 and and general clinical conditions Case Presentation: We report the case of a 14-month-old male, born extremely premature, suffering from severe BPD requiring continuous high-flow nasal cannula (HFNC) oxygen therapy, who was hospitalized due to a viral respiratory infection with dyspnea and desaturation. When the child clinically recovered, all attemps of weaning off oxygen led to rapid drops in spO 2 , despite the lack of increased work of breathing or cyanosis and normal PaO 2 . Conclusions: Severe BPD and recurrent respiratory issues could have per se justified the persistently low spO2. Incongruence between low spO 2 values, normal PaO 2 levels and good clinical condition, once the child was recovered, raised suspicion of low oxygen affinity hemoglobin (Hb) variants. Abnormal Hb peak detected through high-performance liquid chromatography allowed rare diagnosis of Hb Titusville, confirmed by molecular analysis. In conclusion, the case matched a rare low oxygen affinity hemoglobinopathy (Hb Titusville), highlighting its relevance in unexplained hypoxemia. Diagnosis challenges necessitate a systematic approach to prevent misinterpretations.
Patria et al. (Mon,) studied this question.