3.5.

Blood Gas Analysis

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 Learning Objectives
Upon completion of this lesson, the student will be able
to:
• Discuss typical pH, pCO2, pO2 and Oxygen saturation
levels in body fluids based on pathophysiological
responses.

• Describe the principle of analysis of pCO2, pH and

pO2 in terms of electronic components, reagents
and endpoint detection.

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 Learning Objectives
Upon completion of the lesson the student will be able
to:

• Describe specimen collection and handling

requirements for electrolyte and blood gas analysis.

• Explain the expected reference ranges of Na, K, Cl,

CO2/HCO3 based on normal physiologic responses.

• Discuss interpretation of electrolyte and blood gas

results
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 Outline
• Introduction
• Source and Clinical Significance
• Methods of Analysis
• Specimen
• Interpretation
• Quality Control
• Sources of Error
• Documentation and Reporting
• Summary

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 Introduction
• Arterial blood gases (ABGs), the most
frequently requested critical tests, used to
monitor and evaluate
– Respiratory function i.e ability to supply
oxygen into the blood and to remove carbon
dioxide from the blood
– Hb transport of oxygen
– Available oxygen to tissues

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 Terminology
• Partial pressure of Oxygen (PO2): dissolved
oxygen gas in the blood
• Partial pressure of Carbon dioxide (PCO 2):
dissolved carbon dioxide in the blood
• pH: potential of H+ concentration
• Bicarbonate (HCO3-): part of major buffer
system; salt form of carbon dioxide
• Oxygen Saturation (SO2) and Oxygen content
(CtO2)-: % of oxyhemoglobin
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 Blood Gas Analysis
1. Partial pressure of Oxygen (PO2)-indicates how well
the oxygen is able to diffuse from the alveolar
membrane into the blood.
2. Partial pressure of Carbon dioxide (PCO2)- indicates
how well the CO2 is able to move out with the
exhaled air.
3. pH- it is the measure of hydrogen ion concentration
[H+] in blood which indicates the acid and base
nature of blood.

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 Blood Gas Analysis

4. Bicarbonate (HCO3-)-It is the most important

buffer of the blood
5. Oxygen Saturation (SO2) and Oxygen content
(CtO2)- provide information about the
amount of oxygen (dissolved and bind with
Hb) in the blood

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 Oxygen in Blood

Total O2 content (ctO2) = sum of oxyhemoglobin

(O2Hb) and of dissolved O2 (cdO2). i.e. ctO2 =
O2Hb + cdO2.

1. PO2 normally 90mmHg.

2. Hypoxemia (lowPO2) results in O2 starvation
of tissues.
3. Decreased Hb in g/dL in anemic hypoxia.

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 Oxygen in Blood
Factors to ensure adequate O2 supply
4.Hb affinity to O2.
• Increased affinity of Hb in Hb F response
to tissue hypoxia.

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 Factors affecting Oxygen binding to Hb
• Association or dissociation of O2 with Hb depends
on:
– PO2, and
– Affinity of Hb for O2 .
• Affinity of Hb for O2 depends on:
1. Temperature
2. pH
3. pCO2
4. Hemoglobinopathies
5. Concentration of 2,3-D PG

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 Oxygen –Hb Dissociation Curve

1.0
pH
0.8 7.6
7.4 S02=Hb 02 satur-
0.6 7.2
ation
0.4 p02=partial pres-
0.2 sure of oxygen

S02
(Hgb) 20 40 60 80 100

pO2 mmHg
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 Details of the Oxygen –Hb Dissociation Curve
• Increase in [H+], PCO2, 2-3DPG, and Temp.
decrease the affinity of Hb for O2; curve shifts to
the right.

• Patient oxygenation status is determined by the

pO2 result

• pO2 < 60mm Hg are considered as hypoxia

• pO2 decreases normally with age.

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 Analysis of Blood Gases
• General Principles
– The analyzer is designed to measure pH, pCO2, pO2
and calculate HCO3- simultaneously.
– Some analyzers also measure SO2 .
– Each individual electrode will be discussed.

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 Blood Gas Analysis: pH
• Glass electrode selective for
H+
• Ag/AgCl Reference
electrode
• KCl salt bridge
•  potential proportional to
pH

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 Blood Gas Analysis: pCO2
• Gas selective
membrane
• pH change is measured
• Versus reference
electrode

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 Blood Gas Analysis: pO2
• pO2 permeable
membrane
• Platinum cathode
• Anode detecting
electrons

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 Blood Gas Specimens
• Heparinized whole blood, arterial
• Heparinized whole blood, capillary

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Interpretation of Blood Gas Results
Reference Ranges adult arterial :
• pH 7.35- 7.45
• pCO2 35- 45 mmHg
• HCO3- 22-26 mmol/L
• pO2 83-108 mm Hg
• Compare patient results with reference ranges
to determine if any results are outside of
normal limits.
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 Quality Control
• A normal & abnormal quality control whole
blood sample should be analyzed along with
patient samples, using Westgard or other quality
control rules for acceptance or rejection of the
analytical run.
– Assayed known samples
– Commercially manufactured

• Validate patient results

• Detects analytical errors.
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 Quality Control Monitoring for
Analytic Errors
• QC performed daily &
following calibration
• Plot on chart
• Follow QC rules
• Determine if current
patient results are
acceptable

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 Sources of Error
• Wrong anticoagulant or no anticoagulant
• Venous instead of Arterial (adult)
• Not preserved well
– Opened
– Warm
– Not fresh

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 Reporting and Documentation
• To avoid post-analytic errors,
• Report the patient result with :
– Right name and result
– Include reference ranges
– Timely manner

• QC and patient results should be documented

in logbook and retained in lab
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 Summary of Blood Gas Analysis
This lesson emphasized on:
• Source and Clinical Significance of Blood Gases
(pH, pCO2 and pO2)
• Methods of Analysis, Specimen, Interpretation
compared to reference ranges
• Quality Control, Sources of Error, and
Documentation and Reporting

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 References
• Burtis, C and Ashwood: W.Tietz, Phd, et al.
Electrolytes and Blood Gases, In : Fundamental of
Clinical Chemistry 5th ed 2001 by Saunders.
• W Arneson and J Brickell: Clinical Chemistry: A
Laboratory Perspective 1st ed. 2007 FA Davis

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• The next chapter deals with principle of
immunochemistry

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