153-##_Other-1032-1-11-20220111.jpg


Volume 9- No. 7 2021

Educated Hand Publishing LLC 
“The Science Behind the Art” 
Volume 9 - No.7 2021 

 Anesthesia eJournal - Online
ISSN 2333-2611

Page 13

Decreased Pulse Oximetry Readings in Asymptomatic Patient with Hemoglobin Grifton 
Anne Marie Serrano1, Christian R Serrano2, and Monica Jenschke3

Affiliation:
 1 Anne Marie Serrano, BSN, RN, Texas Christian University, School of Nurse Anesthesia, Fort Worth, TX
2 Christian R Serrano, MS, BS, Department of Biology, University of Texas at San Antonio, San Antonio, TX
3 Monica Jenschke, PhD, CRNA, Texas Christian University, School of Nurse Anesthesia, Fort Worth, TX 

Grant/Financial Support: 
None

Biographical data:  
Elaine Juch is a senior RRNA at Texas Christian University in Fort Worth. She would like to acknowledge the work of Courtney 
McNeill, CRNA, preceptor for guidance during this unique case. 

KEYWORDS: Hemoglobin Grifton, hemoglobinopathies, pulse oximetry 

Abstract
Hemoglobin Grifton presents as a decreased oxygen saturation as measured by pulse oximetry (SpO2) reading despite a 
normal arterial oxygen saturation (SaO2) in an asymptomatic patient. Hemoglobin Grifton is caused by a mutation on 
an alpha chain of hemoglobin at codon 87, which affects the absorption wavelength of its oxyhemoglobin. A standard 
pulse oximeter is designed to measure the absorption of light at specific wavelengths and perceives the hemoglobin 
Grifton oxyhemoglobin as a deoxyhemoglobin. In a patient with a known variant hemoglobin, ordering additional 
diagnostic or therapeutic testing can increase stress for a patient requiring routine medical interventions or emergencies. 
Careful evaluation of each individual case is warranted prior to proceeding with an anesthetic. Previous case studies 
reported variant hemoglobinopathies, specifically on the alpha chain, that produce a false low SpO2 reading. In these 
case studies, the arterial blood gas resulted in normal oxygen saturation. Another case study reported that the issue with 
hemoglobin Grifton was the oxyhemoglobin Grifton absorbed light at approximately 740 nm. The light absorption 
on normal oxyhemoglobin is at a wavelength of 940 nm. Because of this, the hemoglobin Grifton is detected by the 
pulse oximeter monitor as deoxyhemoglobin. Standard transcutaneous pulse oximeters do not consider the different 
absorbance spectra of variant hemoglobinopathies where the oxyhemoglobins may be absorbed at lower spectrums. In 
all the literature reviewed, patients went through a myriad of unnecessary diagnostic tests to figure out the cause of the 
hypoxia. Some patients were even prescribed treatment based on this false hypoxia. This results in unnecessary additional 
expenses for treatment and can also cause stress for patients. The patient in this case study presented with a baseline 
SpO2 of 84% with a known diagnosis of hemoglobin Grifton. The surgeon was unable to do this procedure in the clinic 
due to the child’s agitated behavior and general anesthesia was required. The decision was made to forgo invasive testing 
due to her known condition and the unnecessary stress it would add to the patient. 

AEJ