Class Code: 0962C ID Number: 2190966 Date of Submission: October 13, 2020

Name: AQUINO JUSTINE D.

MLS 312 Lecture
Family Name First Name M.I.

EVALUATE - QUIZ 1B - HEMOGLOBIN AND OXYGEN DISSOCIATION CURVE

Essay. Answer briefly but concisely.

1. Why do people living at high altitudes have higher hemoglobin levels? (5 points) How
does the body adapt to changes in oxygen levels at higher altitudes? (5 points).
- In high altitude areas, the oxygen tension is low because there is a low partial
pressure of oxygen needed to compress the oxygen molecules in the air. This results
in the molecules being farther away from each other, making the air we breathe with
relatively fewer oxygen molecules. This leads to an increased respiratory demand as
there is a low oxygen tension in the tissues. Hence, in order to cope up with the low
oxygen levels, the body’s response is to increase hemoglobin to maximize the
delivery of oxygen to the tissues. Subsequent redistribution of total body water, with
fluid being shifted from the circulation and deposited into the interstitial space rapidly
increases the concentration of hemoglobin and therefore enhance the carriage of
oxygen for any given volume of blood. Other response of the body includes the
action of hypoxia inducible factor‐1α that increases erythrpoietin necessary for red
blood cell production. Other races respond by increasing the rate and depth of their
breathing in order to ensure adequate oxygenation.

2. A newly established sub-national testing and referral center for hematologic diseases is
conducting screening procedure to establish the reference values for mothers and their
newborns who are both presumed to be normal or healthy. As part of the screening
procedure, hemoglobin levels and hemoglobin fractionation and quantification using high
performance liquid chromatography (HPLC) were performed on the mother and her
newborn infant. The mother’s haemoglobin concentration was 125 g/L, and the
newborn’s was 210 g/L. The mother’s haemoglobin fractions were quantified as 97% Hb
A, 2% Hb A2, and 1% Hb F by HPLC. The newborn’s results showed 88% Hb F, 10% Hb
A, and 2% Hb A2.

a. Were these hemoglobin results within expected reference intervals? (2 points)

- Yes, the hemoglobin results of both the mother (125 g/L) and the infant (210 g/L)
were within the expected reference intervals of 120-150 g/L and 165-215 g/L,
respectively.

b. Why were the mother’s and the newborn’s hemoglobin concentration so different? (5
points)
- The hemoglobin concentration of the mother and the infant were different with the
infant having significantly higher levels of haemoglobin. This is because the
predominant fetal hemoglobin in the newborn has a greater affinity towards
oxygen. It has a high oxygen affinity because it weakly binds 2,3-
bisphosphoglycerate (2,3-BPG), resulting in decreased delivery of oxygen to the
tissues. This results to hypoxia which then triggers an increase in synthesis of
erythropoietin by the fetal kidney, which further results in an increase in the
production and release of red blood cells from the fetal bone marrow. The
resultant increase in red blood cell count, hemoglobin concentration, and
 hematocrit compensates for the high Hb F oxygen affinity and reduced oxygen
transfer to tissues. The Hb F concentration gradually decreases to adult
physiologic levels by 1 to 2 years of age as most of the Hb F is replaced by Hb A.
HbA1 has less affinity to oxygen compared to HbF and readily releases it to the
tissues. Therefore, the increased hemoglobin concentration of the infant for
oxygen nourishment compensation is due to the combination of fetal hemoglobin
and increasing adult hemoglobin in the body of the newborn.

c. What is the difference between the test to determine the haemoglobin concentration
and the test to analyze hemoglobin by HPLC? (5 points)
- The hemoglobin assay measures hemoglobin concentration while the high
performance liquid chromatography including hemoglobin electrophoresis)
identifies and quantifies hemoglobin variants.

d. Why were the mother’s and newborn’s hemoglobin fractions so different? (5 points)
- For a healthy mother and infant, these hemoglobin fraction variations were
considered as normal. In the second and third trimesters of fetal life, the alpha
and gamma globin genes are activated, producing alpha and gamma globin
chains. These chains combine to form Hb F. In late fetal life, gamma-beta
switching begins in which transcription of the beta-globin gene begins to be
upregulated and the gamma-globin gene begins to be downregulated. This
increase in the transcription of the beta-globin gene, allows the beta chains to
combine with the alpha chains to form Hb A. These mechanisms result to Hb F
level decreasing from 60% to 90% at birth to 1% to 2% by 1 to 2 years of age,
and the HbA increases from 10% to 40% at birth to greater than 95% at 1 to 2
years of age and throughout life. The synthesis of HbA2 begins shortly before
birth and remains at less than 3.5% throughout life.

e. When will the hemoglobin level and fractions of the newborn infant switch to normal
adult level and fractions? (3 points)
- The hemoglobin level and fractions of the newborn infant switch to normal adult
level and fractions by the end of the 6th month. By 6 months of age and through
adulthood, Hb A is the predominant hemoglobin, with small amounts of Hb A2
and Hb F.