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Airflow, pressure, and resistance
Alveolar gas equation
Breathing cycle and regulation
Diffusion-limited and perfusion-limited gas exchange
Fick's laws of diffusion
Gas exchange in the lungs, blood and tissues
Ideal (general) gas law
Reading a chest X-ray
Respiratory system anatomy and physiology
Alveolar surface tension and surfactant
Combined pressure-volume curves for the lung and chest wall
Compliance of lungs and chest wall
Carbon dioxide transport in blood
Oxygen binding capacity and oxygen content
Oxygen-hemoglobin dissociation curve
Anatomic and physiologic dead space
Lung volumes and capacities
Pulmonary changes at high altitude and altitude sickness
Pulmonary changes during exercise
Pulmonary chemoreceptors and mechanoreceptors
Regulation of pulmonary blood flow
Ventilation-perfusion ratios and V/Q mismatch
Zones of pulmonary blood flow
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oxygen-hemoglobin dissociation curve p. 689
The oxygen-hemoglobin dissociation curve shows how the hemoglobin saturation with oxygen (SO2,), is related to the partial pressure of oxygen in the blood (PO2).
Hemoglobin is the main protein within red blood cells, and it’s made of four globin subunits, each containing a heme group capable of binding one molecule of O2.
So each hemoglobin protein can bind 4 molecules of oxygen. But each hemoglobin isn’t always 100% saturated or bound by oxygen.
A hemoglobin molecule might have no oxygen bound, and be 0% saturated, called deoxyhemoglobin, and it will take on a tense state shape, or T-state; or it might have one oxygen bound and three open spots, meaning that particular protein would be 25% saturated; or two filled spots and two open spots—50%; or 3 spots filled and one spot open—75%, or all spots filled and 100% saturated.
All of these states - where oxygen is bound to hemoglobin - are called oxyhemoglobin, changing to its relaxed state, or R-state with each O2 molecule that binds.
And since there are millions of hemoglobin molecules in a single cell and millions of red blood cells, the hemoglobin saturation of oxygen is the average saturation among all of these proteins.
Now it turns out that hemoglobin absorbs different wavelengths of light as it gets more and more oxygenated.
A technique called pulse oximetry uses this property of hemoglobin to figure out the average oxygen saturation across millions of hemoglobin proteins.
The main factor that influences oxygen saturation is the partial pressure of oxygen in the blood, measured in millimeters of mercury (mm Hg).
So for example, at a partial pressure of 25mmHg, hemoglobin proteins might be 50% saturated, called P50; and at a partial pressure of 100mmHg, they might be 98% saturated, meaning most are fully saturated.
And when these points are plotted, the curve takes on a sigmoidal shape.
In practical terms, this sigmoidal shape means that hemoglobin has an increasing affinity for O2 as the number of bound O2 molecules goes up.
So binding that 4th O2 molecule is much easier than binding that first O2 molecule. This is called positive cooperativity.
Around 60mmHg, the vast majority of the hemoglobin subunits have bound oxygen, so the curve starts to level off.
That’s why in arterial blood where the partial pressure of oxygen is around 100mmHg, hemoglobin get fully saturated with oxygen.
And why in the venous capillaries of tissues, where the partial pressure of oxygen is about 40mmHg, hemoglobin is only about 75% saturated with oxygen.
In other words, about a quarter of the oxygen that’s bound to the hemoglobin gets dropped off, or unloaded, in the tissues.
Now, there are a few factors that can cause hemoglobin’s affinity for O2 to change.
The oxygen-hemoglobin dissociation curve is a graphical representation of the relationship between the amount of oxygen bound to hemoglobin and the partial pressure of oxygen in the blood. The curve is sigmoidal, with a steep slope at low partial pressures of oxygen and a more gradual slope at higher partial pressures. This allows hemoglobin to bind oxygen efficiently at a wide range of partial pressures, ensuring that the body's tissues receive an adequate supply of oxygen.
However, factors like PCO2, pH, temperature, 2-3-DPG, hemoglobin type, and carbon monoxide can all affect the oxygen-hemoglobin affinity, causing a shift in the oxygen-hemoglobin dissociation curve to the right or left, as they make hemoglobin more or less likely to unload oxygen in the tissues.
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