Pulse oximetry - This is easily one of the most common and most useful tool in everyday Medicine to manage in hospital, nursing home, clinic patients etc.It tells us what percentage of hemoglobin is saturated with Oxygen- SO2. When measured in arterial blood, we call it SaO2.
Mechanism - Every pulse oximeter has 3 components - 1. a source emitting 2 wavelengths of light- red & infrared 2. receiver receiving these lights after after passing through the finger or ear lobe 3. a unit processing this information.
The Hemoglobin (Hb) in circulation is mostly in the oxidised form(OxyHb) ..and some in reduced form(deoxyHb). OxyHb absorbs red light and deoxy Hb absorbs infrared light. When the oximeter probe is clipped on the finger, the emitter sends the red & infrared signals. These are absorbed by the respective Hbs (OxyHb - red ,& deoxyHb- infrared). The receiver receives the remaining light. The processing unit then calculates the SaO2 by the following formula...
SaO2(SpO2) = Oxy Hb / OxyHb + deoxyHb x 100
Carboxyhb & MetHb - In case of suspected carboxy or meth hemoglobenemia....the calculation is done by adding them to the denominator. CarboxyHb is bright red in color, and absorbs red light(as OxyHb). Now we can understand the reason behind normal SaO2 in patients with high CarboxyHb (poisoning & low levels in smokers). This can be corrected by using an oximeter emitting 4 wavelengths of light instead of two. But its not usually done...due to the rarity of these disorders.
Venous Vs arterial sats - Well...venous circulation on the finger tip also has oxyHb & deoxyHb. So how does the oximeter differentiate? ...It is designed to pick up signals only from pulsatile wave forms. So we only get a SaO2....not a SvO2. Because of this...it may not be reliable in people with peripheral vascular disease or in patients with severe tricuspid regurgitation (pulsatile veins).
Anemia - Low Hb does not affect SaO2, as it does not measure the amount of Oxygen in Hb, but the percentage of Hb saturated with Oxygen. i.e occupying the Fe-protporphyrin complexes. So even if Hb is 5g/dl,but all 5 g is well saturated with Oxygen..the oximeter will read 100% SaO2. Another point here....anemia also does not affect partial pressure of O2(PaO2). The only parameter anemia..affects is the Oxygen content of blood.(which we dont need in clinical practice!)
Lastly...anyhting that interferes mechanically with the light wavelengths (e.g red nail polish, sometime dark skin)will affect the oximeter reading.
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