The oxygenhemoglobin dissociation curve (or oxygenhemoglobin dissociation

curve) plots the proportion of hemoglobin in its saturated form on the vertical axis
against the prevailing oxygen tension on the horizontal axis. The oxyhemoglobin
dissociation curve is an important tool for understanding how our blood carries and
releases oxygen. Specifically, the oxyhemoglobin dissociation curve relates oxygen
saturation (SO2) and partial pressure of oxygen in the blood (PO2), and is determined by
what is called "hemoglobin's affinity for oxygen"; that is, how readily hemoglobin
acquires and releases oxygen molecules into the fluid that surrounds it.

Contents
[hide]

1 Background
2 Sigmoidal shape
3 Factors that affect the standard dissociation curve
o 3.1 Variation of the hydrogen ion concentration
o 3.2 Effects of carbon dioxide
o 3.3 Effects of 2,3-DPG
o 3.4 Temperature
o 3.5 Carbon monoxide
o 3.6 Effects of methemoglobinaemia
4 Fetal hemoglobin
5 References

6 External links

[edit] Background
Hemoglobin (Hb), a globular protein, is the primary vehicle for transporting oxygen in
the blood. Oxygen is also carried dissolved in the blood's plasma, but to a much lesser
degree. Hemoglobin is contained in erythrocytes, more commonly referred to as red
blood cells. Under certain conditions, oxygen bound to the hemoglobin is released into
the blood's plasma and absorbed into the tissues. Each hemoglobin molecule has the
capacity to carry four oxygen molecules. How much of that capacity is filled by oxygen
at any time is called the oxygen saturation. Expressed as a percentage, the oxygen
saturation is the ratio of the amount of oxygen bound to the hemoglobin, to the oxygencarrying capacity of the hemoglobin. The oxygen-carrying capacity of hemoglobin is
determined by the type of hemoglobin present in the blood. The amount of oxygen bound
to the hemoglobin at any time is related, in large part, to the partial pressure of oxygen to
which the hemoglobin is exposed. In the lungs, at the alveolarcapillary interface, the
partial pressure of oxygen is typically high, and therefore the oxygen binds readily to
hemoglobin that is present. As the blood circulates to other body tissue in which the
partial pressure of oxygen is less, the hemoglobin releases the oxygen into the tissue
because the hemoglobin cannot maintain its full bound capacity of oxygen in the
presence of lower oxygen partial pressures

[edit] Sigmoidal shape

Hemoglobin saturation curve.

It is usually a sigmoid plot. A hemoglobin molecule can bind up to four oxygen
molecules in a reversible way.
The shape of the curve results from the interaction of bound oxygen molecules with
incoming molecules. The binding of the first molecule is difficult. However, this
facilitates the binding of the second and third molecules, and it is only when the fourth
molecule is to be bound that the difficulty increases, partly as a result of crowding of the
hemoglobin molecule, partly as a natural tendency of oxygen to dissociate.
In its most simple form, the oxyhemoglobin dissociation curve describes the relation
between the partial pressure of oxygen (x axis) and the oxygen saturation (y axis).
Hemoglobin's affinity for oxygen increases as successive molecules of oxygen bind.
More molecules bind as the oxygen partial pressure increases until the maximum amount
that can be bound is reached. As this limit is approached, very little additional binding
occurs and the curve levels out as the hemoglobin becomes saturated with oxygen. Hence
the curve has a sigmoidal or S-shape. At pressures above about 60 mmHg, the standard
dissociation curve is relatively flat, which means that the oxygen content of the blood
does not change significantly even with large increases in the oxygen partial pressure. To
get more oxygen to the tissue would require blood transfusions to increase the
hemoglobin count (and hence the oxygen-carrying capacity), or supplemental oxygen that
would increase the oxygen dissolved in plasma. Although binding of oxygen to
hemoglobin continues to some extent for pressures about 50 mmHg, as oxygen partial
pressures decrease in this steep area of the curve, the oxygen is unloaded to peripheral
tissue readily as the hemoglobin's affinity diminishes. The partial pressure of oxygen in
the blood at which the hemoglobin is 50% saturated, typically about 26.6 mmHg for a
healthy person, is known as the P50. The P50 is a conventional measure of hemoglobin
affinity for oxygen. In the presence of disease or other conditions that change the
hemoglobin's oxygen affinity and, consequently, shift the curve to the right or left, the
P50 changes accordingly. An increased P50 indicates a rightward shift of the standard
curve, which means that a larger partial pressure is necessary to maintain a 50% oxygen

saturation. This indicates a decreased affinity. Conversely, a lower P50 indicates a

leftward shift and a higher affinity.
The 'plateau' portion of the oxyhemoglobin dissociation curve is the range that exists at
the pulmonary capillaries (minimal reduction of oxygen transported until the p(O2) falls
50 mmHg).
The 'steep' portion of the oxyhemoglobin dissociation curve is the range that exists at the
systemic capillaries (a small drop in systemic capillary p(O2) can result in the release of
large amounts of oxygen for the metabolically active cells).
To see the relative affinities of each successive oxygen as you remove/add oxygen
from/to the hemoglobin from the curve compare the relative increase/decrease in p(O2)
needed for the corresponding increase/decrease in s(O2).

[edit] Factors that affect the standard dissociation curve

The strength with which oxygen binds to hemoglobin is affected by several factors. These
factors shift or reshape the oxyhemoglobin dissociation curve. A rightward shift indicates
that the hemoglobin under study has a decreased affinity for oxygen. This makes it more
difficult for hemoglobin to bind to oxygen (requiring a higher partial pressure of oxygen
to achieve the same oxygen saturation), but it makes it easier for the hemoglobin to
release oxygen bound to it. The effect of this rightward shift of the curve increases the
partial pressure of oxygen in the tissues when it is most needed, such as during exercise,
or hemorrhagic shock. In contrast, the curve is shifted to the left by the opposite of these
conditions. This leftward shift indicates that the hemoglobin under study has an increased
affinity for oxygen so that hemoglobin binds oxygen more easily, but unloads it more
reluctantly. Left shift of the curve is a sign of hemoglobin's increased affinity for oxygen
(e.g. at the lungs). Similarly, right shift shows decreased affinity, as would appear with an
increase in body temperature, hydrogen ion, 2,3-diphosphoglycerate (also known as
bisphosphoglycerate) or carbon dioxide concentration (the Bohr effect)
left shift (high affinity for O2)
temperature
decrease
2.3-DPG
decrease
p(CO2)
decrease
p(CO)
increase
pH (Bohr effect)
increase (alkalosis)
type of hemoglobin fetal hemoglobin

right shift (low affinity for O2)

increase
increase
increase
decrease
decrease (acidosis)
adult hemoglobin

The causes of shift to right can be remembered using the mnemonic, "CADET, face
Right!" for CO2, Acid, 2,3-DPG, Exercise and Temperature.[1] Factors that move the
oxygen dissociation curve to the right are those physiological states where tissues need
more oxygen. For example during exercise, muscles have a higher metabolic rate, and

consequently need more oxygen, produce more carbon dioxide and lactic acid, and their
temperature rises.

[edit] Variation of the hydrogen ion concentration

This changes the blood's pH. A decrease in pH shifts the standard curve to the right, while
an increase shifts it to the left. This is known as the Bohr effect.[2] A reduction in the total
binding capacity of hemoglobin to oxygen (i.e. shifting the curve down, not just to the
right) due to reduced pH is called the root effect. This is seen in bony fish.

[edit] Effects of carbon dioxide

Carbon dioxide affects the curve in two ways: first, it influences intracellular pH (the
Bohr effect), and second, CO2 accumulation causes carbamino compounds to be
generated through chemical interactions, which bind to hemoglobin forming
carbaminohemoglobin. Low levels of carbamino compounds have the effect of shifting
the curve to the right, while higher levels cause a leftward shift. However, this isn't the
overriding effect of CO2 accumulation. Only about 510% of the total CO2 content of
blood is transported as carbamino compounds. Most of the CO2 content (8090%) is
transported as bicarbonate ions. The formation of a bicarbonate ion will release a proton
into the plasma. Hence, the elevated CO2 content creates a respiratory acidosis and shifts
the oxygenhemoglobin dissociation curve to the right.

[edit] Effects of 2,3-DPG

2,3-Diphosphoglycerate or 2,3-DPG (also 2,3-bisphosphoglycerate or 2,3-BPG) is an
organophosphate, which is created in erythrocytes during glycolysis. The production of
2,3-DPG is likely an important adaptive mechanism, because the production increases for
several conditions in the presence of diminished peripheral tissue O2 availability, such as
hypoxaemia, chronic lung disease, anaemia, and congestive heart failure, among others.
High levels of 2,3-DPG shift the curve to the right, while low levels of 2,3-DPG cause a
leftward shift, seen in states such as septic shock and hypophosphataemia.[2]

[edit] Temperature
Temperature does not have such a dramatic effect compared to the previous factors, but
hyperthermia causes a rightward shift, while hypothermia causes a leftward shift.

[edit] Carbon monoxide

Hemoglobin binds with carbon monoxide 200-250 times more readily than with oxygen.
[2]
The presence of carbon monoxide on one of the 4 heme sites causes the oxygen on the
other hem sites to bind with greater affinity. This makes it difficult for the hemoglobin to
release oxygen to the tissues and has the effect of shifting the curve to the left (as well as
downward, due to direct competitive effects of carbon monoxide). With an increased

level of carbon monoxide, a person can suffer from severe tissue hypoxia while
maintaining a normal pO2.

[edit] Effects of methemoglobinaemia

Methemoglobinaemia is a form of abnormal hemoglobin where ferrous (Fe2+), which is
normally found in hemoglobin, is converted to the ferric (Fe3+) state. This causes a
leftward shift in the curve as methemoglobin does not unload O2 from Hb. However,
methemoglobin has increased affinity for cyanide, and is therefore useful in the treatment
of cyanide poisoning.

[edit] Fetal hemoglobin

Fetal hemoglobin (HbF) is structurally different from normal hemoglobin (Hb). The fetal
dissociation curve is shifted to the left relative to the curve for the normal adult.
Typically, fetal arterial oxygen pressures are low, and hence the leftward shift enhances
the diffusion of oxygen across the placenta. At the placenta there is a higher concentration
of 2,3-DPG formed. This binds more readily to adult hemoglobin but not to fetal
hemoglobin. This causes the adult Hb to release more oxygen at the placenta to be taken
up by the fetus. Fetal Hb is made up of gamma chains not beta ones, and 2,3-DPG does

not bind readily to gamma chains, hence it does not give up its oxygen.[3]

[edit] References
1.

^ "Medical mnemonics". LifeHugger.

http://mc.lifehugger.com/moc/67/oxygen-hemoglobin-dissociation-curve-causesshift-right. Retrieved 2009-12-19.
2.
^ a b c Jacquez, John (1979 pages=156-175). Respiratory Physiology.
McGraw-Hill.
3.
^ Lippincott's Illustrated Review: Biochemistry 4th edition. North
America: Lippincott, Williams, and Wilkins. 2007. pp. 2435. ISBN 9780781769600.