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LC, ME/CFS, FM, APS: venous blood gases measurement for diagnostics of hypoxemia, hypoperfusion, hypercoagulability, microclots... 2021, Aguirre Chang

Discussion in 'ME/CFS research' started by Sly Saint, Oct 23, 2022.

  1. Sly Saint

    Sly Saint Senior Member (Voting Rights)





    For patients with Long COVID, Post-Vaccine COVID Syndrome, Chronic Fatigue Syndrome, Fibromyalgia, Chronic Pain, RA, Antiphospholipid Syndrome, Adrenal Insufficiency or Fatigue, POTS, Lyme, EBV and other Diseases that present Chronic Fatigue and Brain Fog. Chronic Fatigue and Brain Fog symptons are associated with endothelial cell dysfunction, tissue hypoperfusion, hypercoagulability, and persistent microclots.

    In recent years, several studies have been published in which it is evidenced that, both in Chronic Fatigue Syndrome (CFS), and in patients who present various neurological symptoms known as a whole under the name of Brain Fog, there is a dysfunction endothelial cells that form the walls of blood vessels, persistent, in addition to decreased blood flow and decreased perfusion to cells and tissues of the body, which is called tissue hypoperfusion.

    At the end of this document, we mention in the references the most relevant studies in this regard (1-6). For our part, in previous publications we have explained that Chronic Fatigue, Brain Fog and other symptoms present in Chronic Fatigue Syndrome (CFS), in Persistent Symptoms of COVID, Chronic Lyme Disease, Fibromyalgia and in other associated Chronic Diseases a Persistent intracellular infections, are associated with platelet hyperactivity, dysfunction of endothelial cells and pericytes, reduction of endothelial glycocalyx, presence of persistent clots and alterations in blood cells (7-11).

    According to our approach, in almost all cases of Long COVID and in 3 out of 4 cases of CFS there is an inadequate long-term functioning of the blood vessels, and in a high percentage of these cases this dysfunction is accompanied by an increase in the density of the blood and the presence of persistent clots that are attached to the vascular walls and are also circulating intravascularly as part of the bloodstream.

    Implications of Hypoperfusion. Long-term dysfunction of the blood vessel walls and the presence of persistent clots cause tissue hypoperfusion, which implies a lower contribution to the tissues of oxygen (generating hypoxia), of nutrients, vitamins, hormones and other substances, for which affects the normal functioning of the organs and systems, especially those that require a greater supply of oxygen and nutrients, which are mainly the musculoskeletal system, the brain and the lungs.
    There is then a functional limitation and intolerance to exertion.

    Hypoperfusion is not detectable with routine exams. Tissue Hypoperfusion generates an inadequate functioning of various organs and systems, especially when these are required, but there is no obvious damage to the tissues, which is why most of the tests that are routinely requested, are usually normal (12), such as X-rays, CT scans, and routine laboratory tests. Venous Blood Gases Measurement to evaluate Venous Oxygen Saturation (SvO2).

    An accessible diagnostic aid test that is much lower cost than the PET Scan, SPECT/CT and other tests indicated to investigate the presence of tissue Hypoperfusion, is the Venous Oxygen Saturation (SvO2 or Sat vO2) blood test, for which requires that the patient be asked for a Venous Blood Gases Measurement, since SvO2 is part of the results that are reported with this test (13).

    The Venous Blood Gases test is also known as Venous Gasometry, or Measurement of Gases of the veins. Its cost is between 20 to 45 US dollars. Venous Oxygen Saturation (SvO2) is also known as Venous Blood Oxygen Saturation or Mixed Venous Saturation. Sample collection procedure for Measurement of Venous Blood Gases.

    The procedure for taking a blood sample to perform the Venous Blood Gases Measurement analysis is similar to the procedure performed for routine blood tests such as blood count or cholesterol, that is, the sample is generally taken from a vein of one of the patient's arms, the amount of blood required is small and in this case of Venous Blood Gases Measurement it is not necessary for the patient to be fasting.

    What is indicated is that the processing of the sample is carried out quickly, since as time passes, the level of oxygen in the sample obtained decreases The result is usually delivered in a short time, after a few hours after taking the sample. Normal Venous Oxygen Saturation Values (SvO2). Although there are some variations in terms of normal parameters depending on the laboratory where it is processed or according to the parameters of the healthcare center, the accepted Normal Value for an optimal Venous Oxygen Saturation (SvO2) for the functioning of the organism is 66% or more for most laboratories and hospitals, but some consider normal from 62%.

    In general, and based on existing publications and our clinical experience, we consider that the optimal normal value of SvO2 is above 65%. Between 61 and 65% we consider it an intermediate or borderline value, that is, a value that is between the values of the normal lower limit of saturation and the values very slightly below normal From 60% to less than SvO2 we consider it a value below normal.

    Slightly Low Values of SvO2 and Adapted Hypoxia. We consider 50% to 60% of SvO2 to be a low value, but in patients with a chronic illness or syndrome this is a value that is equivalent to mild hypoxia, since the body is adapted and can fulfill most of its functions. normally, this as long as the patient does not make a physical effort. As long as the SvO2 does not fall below 50%, an adapted or compensated hypoxia is produced, in which the cells can still maintain all their functions. Moderately Low SvO2 Values. A value of 30 to 49% SvO2 is considered to be a moderately low SvO2 value for patients with a chronic disease or a syndrome with persistent symptoms.

    According to our experience with the evaluated patients, those who show symptoms associated with hypoperfusion, hypercoagulability and microclots, usually have an SvO2 result of between 24 and 48%, and with the established treatments the values improve significantly, the objective being that the SvO2 rises to more than 60%, and that it remains at these levels, since there are cases in which, when discontinuing the therapies, their symptoms and SvO2 values worsen again, a situation that we associate with to the presence of a persistent infection, or to another triggering cause that increases the density of the blood and activates the generation of persistent clots that are difficult to eradicate.

    In a state of normal oxygenation, the cells maintain an aerobic metabolism since the supply of oxygen covers the demand of the tissues. But in a state of moderate or severe hypoxia, when aerobic metabolism is insufficient to produce Adenosine Triphosphate (ATP), cells must resort to alternative pathways to maintain ATP production, thus activating anaerobic metabolism.

    ATP is the main source of energy for cells in living organisms, and is required for almost all forms of biological work, such as muscle contraction, digestion, nerve transmission, gland secretion, etc. Dysoxia with Hyperlactacidemia and high Pyruvate levels. It is considered that when SvO2 drops below 50% and persists at these low oxygenation levels, Dysoxia occurs, which is a state of cellular hypoxia in which ATP production is limited by the very low level of oxygen, therefore, "mitochondrial respiration" cannot be maintained, mitochondrial dysfunction occurs, ATP production decreases and existing ATP depletion occurs, this situation of cellular hypoxia causes the organism to resort to increasing the production of lactate (or lactic acid) from pyruvate, which is why the blood levels of lactate (hyperlactacidemia) and of pyruvate rise, and on the other hand, there is release of different inflammatory mediators.

    Severely low values of SvO2 and Hyperlactacidemia. From 24 to 29% is considered to be a severely low value of SvO2, in these cases the patient is usually in bed or sitting most of the day, and usually requires a wheelchair to get around.

    By performing blood tests, these patients can identify an elevation of lactic acid or lactate, which is known as hyperlactacidemia.

    But there are differences between acute and chronic cases, since in patients with low SvO2 levels for a long time, adaptive changes occur in their body that make them more tolerable at very low SvO2 levels. Extremely low values of SvO2 and Lactic Acidosis. Less than 24% is considered to be an extremely low value of SvO2, with these values the patient is usually bedridden and with compromised sensorium. In these patients, the presence of a decrease in pH can be identified, which is when the pH drops below the minimum of the normal range (7.35 to 7.45), which corresponds to a state of Acidosis of the organism, and in this case it is treated of a metabolic acidosis due to an increase in the levels of lactic acid or lactate in the blood above 3.5 mmol/L, in addition to the accumulation of lactate in the tissues.

    Case Report. According to the first case reports of patients with Long COVID or Persistent COVID Symptoms who have undergone the HELP Apheresis procedure (14), some patients with SvO2 values between 22 and 27% have been identified. before undergoing the procedures.

    HELP comes from the initials of: Heparin-induced Extracorporeal LDL Precipitation. In these cases, when undergoing HELP Apheresis, blood of a darker color, of greater density and with the presence of clots is observed, which in these cases usually remain adhered to the catheters and filters used in this procedure (14). SvO2 values during cardiac arrest.

    If SvO2 is maintained at a level below 18%, it is considered that cell death would occur. It is noted that, while a person is in cardiac arrest, SvO2 is less than 18%, ranging between 5 to 17% while not receiving assistance, and with chest compressions of cardiopulmonary resuscitation (CPR) maneuvers the SvO2 it must rise to 40% or more to be considered effective. Interpretation of a low SvO2 value (Hypoxemia).

    SvO2 tells us the percentage of oxygen bound to hemoglobin in the blood when it returns to the heart. SvO2 is a reflection of how the oxygen saturation level is found in all venous blood in the body, and before it is re-oxygenated at the pulmonary level.

    SvO2 gives us the value of the percentage of oxygen bound to hemoglobin in the blood when it returns to the heart.

    SvO2 is a reflection of how the oxygen saturation level is in all the venous blood of the body, and before it returns to be re-oxygenated at the heart level with the oxygen obtained in the lungs.

    A low SvO2 value indicates that there is less oxygen in the venous blood, this is called Hypoxemia. By extrapolation, it is used as a marker of the way in which oxygen is supplied to the cells and tissues of the organism, so it correlates with a similar degree of cellular hypoxia, or in the case of tissue hypoperfusion, it can be expect a greater degree of severity of cellular hypoxia to appear.

    The finding of a low SvO2 value (Hypoxemia) in patients with Chronic Fatigue and/or Brain Fog, would indicate that these symptoms are due to the presence of cellular Hypoxia and increased Lactate that can produce Lactic Acidosis. Table of Parameters proposed for the Values of SvO2 in patients with Chronic Diseases associated with Hypoperfusion, Hypercoagulability and Persistent Microclots.

    Table 1 shows the details of the proposed parameters to be taken into account for the resulting values in the SvO2 analyses. The values have been adjusted for application in patients with Chronic Diseases or Syndromes associated with Hypoperfusion, Hypercoagulability and Persistent Microclots, such as the cases of Long COVID or Persistent Symptoms of COVID, COVID Post-Vaccine Syndrome, Chronic Fatigue Syndrome, Fibromyalgia, Chronic Lyme, Antiphospholipid Syndrome, Adrenal Insufficiency or Fatigue, POTS and the other diseases that we have mentioned.

    Last edited by a moderator: Oct 23, 2022
    Jacob Richter, RedFox, MeSci and 3 others like this.
  2. Wonko

    Wonko Senior Member (Voting Rights)

    Sounds interesting, but the opinion of someone who knows something about 'it' would be useful.
    Jacob Richter, RedFox, MeSci and 3 others like this.
  3. CRG

    CRG Senior Member (Voting Rights)


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