Hemoglobin variant (hemoglobin Aalborg) mimicking interstitial pulmonary disease.

Hemoglobin Aalborg is a moderately unstable hemoglobin variant with no affiliation to serious hematological abnormality or major clinical symptoms under normal circumstances. Our index person was a healthy woman of 58, not previously diagnosed with hemoglobinopathy Aalborg, who developed acute respiratory failure after a routine cholecystectomy. Initially she was suspected of idiopathic interstitial lung disease, yet a series of tests uncovered various abnormal physiological parameters and set the diagnosis of hemoglobinopathy Aalborg. This led us to examine a group of the index person's relatives known with hemoglobinopathy Aalborg in order to study whether the same physiological abnormalities would be reencountered. They were all subjected to spirometry and body plethysmography, six-minute walking test, pulse oximetry, and arterial blood gas samples before and after the walking test. The entire study population presented the same physiological anomalies: reduction in diffusion capacity, and abnormalities in P(a)O2 and p50 values; the latter could not be presented by the arterial blood gas analyzer; furthermore there was concordance between pulse oximetry and arterial blood gas samples regarding saturation. These data suggest that, based upon the above mentioned anomalies in physiological parameters, the diagnosis of hemoglobinopathy Aalborg should be considered.

The cost-effectiveness of venous-converted acid-base and blood gas status in pulmonary medical departments.

INTRODUCTION: The current use of arterial punctures, when obtaining arterial blood gas and acid-base status of patients, are associated with a risk of side effects such as pain and hematoma, and a small risk of more severe complications. This analysis investigated the cost-effectiveness of a new method, where less painful venous-converted tests are used as an alternative to arterial punctures. METHODS: A cost-utility analysis was conducted from the Danish hospital perspective using a Markov model. The model represents the admission of a typical patient suffering from chronic obstructive pulmonary disease to the Department of Pulmonary Medicine, Aalborg Hospital. Evidence of the effect of the venous-converted tests' pain reduction was converted into short-term gain in quality-adjusted life years (QALYs), using the Danish EuroQol-5 Dimension value set. A Monte Carlo second order simulation of 10,000 hypothetical patients was conducted for a midsized and a small department. RESULTS: Monte Carlo simulation of the incremental cost-effectiveness ratio (ICER) was dominant for a midsized department, and for a small department the mean was £10,645 per QALY gained. The scatter plot of ICERs revealed that at a willingness-to-pay (WTP) of £30,000 per QALY gained, the venous conversion method is >95% cost-effective in a midsized department and 51% in a small department. CONCLUSION: It was concluded that the venous conversion method should be applied to hospitals with midsized pulmonary departments, and could be applied to small pulmonary departments if the WTP is sufficient.