Sulfhemoglobinemia- The green blood in body

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Sulfhemoglobinemia



Introduction
  • It is a rare condition in which there is excess sulfhemoglobin (sulfHb) in the blood.
  • The pigment is a greenish derivative of hemoglobin which cannot be converted back to normal functional hemoglobin.
  • It causes cyanosis even at low blood levels.
  • It occurs when a sulfar atom is incorporated into the Hb molecule.
  • When hydrogen sulfide (H2S) or sulfide ions and ferric ions combine in the blood, the blood is incapable of carrying oxygen.

History
  • In 1866, Hoppe- seyler observed the formation of a green product after reaching Hb-O2 with H2S and called this green derivatives sulfhemoglobin (SulfHb).
  • Naturally occuring sulfHb is postulated to be derived from H2S produced by intestinal bacteria, but the mode of formation has not yet been elucidated.
  • Sulf-Hb seldom exceeds 10% of the total Hb present.
  • These sulfheme derivatives exhibit lower affinity towards O2 compared to the native proteins and cannot be reverted to the normal functional proteins by natural mechanism in the red cells.
Causes
  • Sulfhemoglobinemia is usually drug induced.
Caused by taking medicine that contain drugs such as sulfonamides (sumatriptan), sulfasalazine etc under certain contents.
These drugs have sulfar atoms which is excessive doses can lead to formation of sulfhaemoglobin in the blood.
  • Occupational exposure to H2S gas is also reportedly a cause of Sulfhemoglobinemia.
  • Acute exposure to H2S gas associated with industrial waste effluents or sewage.
  • A high incidence of Sulfhemoglobinemia reported among the population of city with excessive environmental pollution from voiatile sulfar containing compounds.

Symptoms
  • Chocolate brown arterial blood
  • Fatigue
  • Chest pain and tightness
  • Dizziness
  • Foul smell of urine and breath
  • Bruise stain on finger tips
  • Livid discoloration of the skin and lips
  • Tremor of the upper and lower extremities 

Identification
  • Co-oximetry
  • Gas chromatography or HPLC
  • Spectrophotometry
Treatment
  • Suspected chemical agent suspension
  • External Oxygen supply
  • In severe cases, Blood transfusions


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