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Imaging hemoglobin oxygen saturation in sickle cell disease patients using noninvasive visible reflectance hyperspectral techniques: effects of nitric oxide

¹Laboratory of Chemical Physics, National Institute of Diabetes and Digestive and Kidney Diseases, ²Critical Care Medicine Department, Warren G. Magnuson Clinical Center, and ³Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland 20892-0510

Submitted 18 March 2003 ; accepted in final form 29 May 2003

Sickle cell disease is characterized by microvascular occlusion and hemolytic anemia, factors that impair tissue oxygen delivery. We use visible reflectance hyperspectral imaging to quantitate skin tissue hemoglobin oxygen saturation (HbO₂) and to determine whether changes in blood flow during nitric oxide (NO) stimulation or gas administration (therapies proposed for this disease) improve skin tissue oxygen saturation in five patients with sickle cell disease. Compared with six healthy African-American subjects, sickle cell patients exhibited higher forearm blood flows (7.4 ± 1.8 vs. 3.2 ± 0.4 ml·min^–1·100 ml tissue^–1, P = 0.037) but significantly reduced percentages of skin HbO₂ (61.0 ± 0.2 vs. 77.5 ± 0.2%, P < 0.001). Administration of acetylcholine to patients increased blood flow by 15.1 ± 3.8 ml·min^–1·100 ml tissue^–1 and the percentage of skin HbO₂ by 4.1 ± 0.3% (P = 0.02, P < 0.001, respectively, from baseline values). Sodium nitroprusside, a direct NO donor, increased blood flow by 3.9 ± 1.1 ml/min and the percentage of skin HbO₂ by 2.9 ± 0.3% (P = 0.02, P < 0.001, respectively). NO inhalation had no effect on forearm blood flow, yet increased the percentage of skin HbO₂ by 2.3 ± 0.3% (P < 0.001). Percentages of skin HbO₂ were exponentially related to blood flow (R = 0.97, P < 0.001), indicating a limit to skin tissue oxygen saturation at high blood flows. Thus, for acetylcholine infusion leading to blood flows sevenfold greater than those of healthy resting African-American subjects, patients still exhibited lower percentages of skin HbO₂ (65.2 ± 0.2 vs. 77.5 ± 0.2%, P < 0.001). Visible reflectance hyperspectral imaging demonstrates that either the stimulation or the administration of NO pharmacologically or by gas inhalation improves, but does not normalize, skin tissue oxygen saturation in patients with sickle cell disease.

peripheral vascular disease; cardiovascular pharmacology; blood flow

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