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Jiri Dostal

Development Team Member
Posts: 51
One of the common questions we are getting is the incidence and clinical relevance of mild anemia during the exercise. The shift of diss curve of Hb in anemic human down and right is well known. Now with Moxy we have a great chance to look at this question in a detailed level. What your thoughts about it?

Development Team Member
Posts: 49
I am extremely interested in this question, one of the athletes I coach is anemic. I've run a 5/1/5 assessment on her and I'll provide the data here later today when I get a chance.

Development Team Member
Posts: 49
So below you can find the CSV file from the 5/1/5 assessment I did on the athlete I coach who is anemic. Unfortunately she arrived early and did a warmup, so its not perfect data, I'm hoping to rerun the assessment properly sometime next week and see what changes. The athlete has been involved in rowing for only a year, and while strong doesn't have much of an endurance background. Her test has a very high SmO2 level throughout which she had trouble depressing even at a high intensity. Any comments are welcome.

Attached Files
csv Anemiarowertest_1.csv (43.68 KB, 28 views)

Juerg Feldmann

Fortiori Design LLC
Posts: 1,530
Sorry  I am  far behind  on here  so will try to pick up  but we are getting flooded  for the moment  with  many incredible great  questions  and suggestions. I   will share many of them on the forum  so we   see how  and in what incredible direction we may move in a  very short time  with MOXY in the practical field.

 Here  the graph from   the  suggestion  from NKrause  of  a test  in rowing.  A  few  things   of interest. ( not  telling  that this is typical  for Anemia).
1.  Very minimal  drop in SmO2  look the scale  so a very limited   utilization  despite a very high SmO2.
  Indicating a  "sufficient"  delivery of  O2  to the test area  but a very  bad  utilization of the  available O2.
2.  An interesting  opposite trend   of tHb  to  SmO2.  You can see, that in most    rest periods, where tHb  is increasing you see a drop in  SmO2.  We  would in general  expect, that when I stop  SmO2  would go up as  tHb  goes  up or even if tHb  would stay stable  as  now  the demand of  O2  is lower  than during activity  and the delivery is still big  as HR  and respiration  lag  behind. You stop suddenly  but HR  and  Respiration   still go all out  ,  delivering the same amount  of CO  (  and loading  of O2  but less used  so SmO2  would increase.  Here we have the opposite  despite a  rest  and more  tHb  we have a drop in  SmO2 ???????

Now  here before I show you some of our own studies  some  thoughts.
  a) I  do not think  , that  SmO 2 or NIRS  can  make a diagnostic tool  for Anemia.    However I think  SmO2  could be a feedback, whether the treatment  to the Anemia  worked.
  Here   my  ideas:
  1.  In simple term  we  have  2  Anemia  pictures  ( Much more  but  leave it  simple for the moment )
 1.  One   version is a   delivery problem  and the other version is a  utilization problem.
  The delivery problem means   we simply  have not enough red blood cells  to deliver the O2  needed.
  Problem  with SpO2  and SmO2  is, that  this is  only a  " quality " info  not a  quantity info.
 Meaning.  as a simple example.
 I  can have  10 red blood cells  and 9  are loaded  so SpO2  will tell me  90 %   is loaded.
  I  can have  100 red blood cells  and  70  are loaded  so I have only a  70 %  saturation which delivers  much more O2  to  my system , than the 90 %  Saturation.
. So  the %  value  has a relative small value on the quality of the O2  delivery itself  as it is  no   number or  Quantity. Some body with a  delivery Anemia    will look pretty good   in SpO2  and  possibly good in SmO2  but  there is  not a lot of  O2  coming in really.
  In this cases  we may expect  a  much better utilization of  the   small amount of O2  coming in  so the typical situation of a delivery  problem SmO2  trend.
 The Utilization problem  Anemia  is a  situation, where we may have a lot of red blood cells  but they either  can't  load  or they can't    deload.
  In the  first case  we would have a  high tHb  and a   low  SmO2  as we have lot's  of red blood cells  but a high number  is  HHb. This is the case  in   the theory  as  the O2  diss curve  would shift to the right  possible  due to  compensation of   the body  to release  the O2  as low as accepted  to maintain pO2

 In the other case  we may be able to load a  lot  of red blood cells  but they  can't  let go the O2  so we  have very little  SmO2  drop.
.  Now   interesting may be, that  at the beginning of a  load  we  take the O2  first  from Mb  and not  form tHb.
.   If  we  can't  deload  O2  from Hb  to be used  we may  be able  at least to deload to the Mb  so they   are fully loaded again.
  Or  we may  have a problem as mentioned above  to load   the   big number  of  Hb.
  If this would be the case  we would see   in the rest period  an increase in tHb  but  not  as normally seen a  drop in HHb  and an increase in O2Hb  but  the  interesting picture  may occur, that we  may see  an increase in tHb  and an increase in O2 Hb  but as well an increase in HHb as   many of the Hb  may   come into the test area  unloaded.

 Here  a  " normal  5/21/5  assessment  form     most likley a   " normal " client  . Followed by a  5/1/5  assessment  form a  client  who was  short of breath with all anemia   signs  but   blood test   suggested  perfect  Hct  and   Ree blood cell  count.
  But    what about the quality  of O2  transport. look carefully   on the trends.

Summary :  I   am not sure, but I would argue  we  can't diagnose  an Anemia  but we  can use MOXY  to see, whether the intervention was successful.
 Think  how a  5/1/5  picture  may have to look like  if  we   treated  one of the  above options properly. ???
 What is  interesting  is, that  many   clients  I get   from the local  doctores  and we test RRA  we  have  most of them in the CHRS  situation ( Chronic  hypocapnic  respiratory syndrome )   High RF  high  TV and high  VE  but low  EtCO2    but high SpO2.  EtCO2   30 mmHg and below.
   Meaning the  O2  diss curve in this clients  is very  very left  and as  such good loading but  bad release.
 When we  do some simple manipulation  with respiration we  can immediatly get EtCO2 up and SpO2  down . If  they have  a utilization anemia  they immediatly improve  performance  and  SmO2  drops.
 If  they have a  delivery anemia  they  do not improve performance  that much  but drop super fast  with SmO2.
 So what we need is some clinical  studies   from  bigger groups  to see, whether  NIRS combined  with  respiration could be a  diagnostic indication of   Anemia  as I    name  them  ( Utilization anemia  versus delivery anemia.)
 Here  some more accepted  ideas  on this subject  but very little info  on how they would go  for it.
  One study   which was interesting is the suggestion  that CO2  may play a role   and  therefor    may be  valuable to test it.

Attached Images
Click image for larger version - Name: row_an_thb_smo2.jpg, Views: 24, Size: 56.27 KB  Click image for larger version - Name: langley_ipahd.JPG, Views: 22, Size: 95.70 KB  Click image for larger version - Name: t1_t3_all.JPG, Views: 18, Size: 118.01 KB 

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