Red blood cell (RBC) arteriovenous gap as a marker of hemotransfusion in massive and fulminant hemorrhage with the formation of Multiple Organ Dysfunction Syndrome (MODS). Case report

Authors

DOI:

https://doi.org/10.58676/sjmas.v3i3.115

Keywords:

Biomarker, Arteriovenous AV Gap blood RBC - marker, venous (V) blood RBC, arterial (A) blood RBC, Multiple organ dysfunction syndrome, Acute Respiratory Distress Syndrome, Microcirculatory Mitochondrial Distress Syndrome, pO2 (AV gap), Electro-Ion Membrane Distress Syndrome, Recruitment of microcirculatory – mitochondrial control strategy

Abstract

Background: Massive and fulminant hemorrhage frequently leads to critical states such as hemorrhagic shock and Multiple Organ Dysfunction Syndrome (MODS). Early diagnostic and therapeutic decision-making, particularly regarding hemotransfusion, remains a challenge when classical venous indicators do not reflect the severity of hypoxia. This study proposes the arteriovenous red blood cell (RBC) gap and pCO₂ arteriovenous (AV) gap as novel biomarkers for evaluating tissue hypoxia and guiding red blood cell transfusion, especially in cases with visual blood loss exceeding 3 liters. Materials and Methods: This case-based investigation evaluated the diagnostic utility of the RBC arteriovenous gap and the pCO₂ AV gap (>6 mmHg) as markers of Microcirculatory-Mitochondrial Distress Syndrome (MMDS), a precursor of MODS. Analysis included sequential arterial and venous blood gas measurements, lactate monitoring, and oxygenation indices in a patient presenting with severe hemorrhage and signs of MODS. The microcirculatory-mitochondrial recruitment strategy was applied, involving volemic resuscitation, oxygenation correction, and targeted hemotransfusion. Results: Initial measurements revealed a pCO₂ AV gap of 49.7 mmHg, confirming severe tissue hypoxia and MMDS. This gap decreased to 10.2 mmHg following the recruitment strategy, coinciding with the normalization of pH (6.9 → 7.4), improved oxygenation (SO₂ 51% → 98%), and decreased lactate levels (8.2 → 1.8 mmol/L). Despite a normal venous hematocrit (VHct 36%) and hemoglobin (VtHb 12.3 g/dL), arterial samples showed critical reductions (AHct <12%), justifying RBC transfusion. This AV discrepancy provided a reliable medico-legal basis for intervention, which traditional venous markers alone would not have supported. Conclusion: The RBC and pCO₂ AV gaps are effective, underutilized markers for detecting MMDS and guiding hemotransfusion in cases of massive hemorrhage. They reflect systemic hypoxia more accurately than isolated venous parameters. The application of microcirculatory-mitochondrial recruitment strategies improves patient outcomes and supports metabolic recovery, offering a low-tech yet life-saving intervention approach. These findings propose a paradigm shift in intensive care resuscitation strategies and transfusion criteria in critical care.

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https://sjmas.com/index.php/sjmas/article/view/94/86

Vasilieva I., Vasilieva I., Vasilieva M., et al. (2024). Exhaustion of neurotransmitters storage. Special Journal of the Medical Academy and Other Life Sciences., 2(9). https://doi.org/10.58676/sjmas.v2i9.95

https://sjmas.com/index.php/sjmas/article/view/95

Published

2025-05-03

How to Cite

Vasiliev, I., Vasilieva, I., & Vasilieva, M. (2025). Red blood cell (RBC) arteriovenous gap as a marker of hemotransfusion in massive and fulminant hemorrhage with the formation of Multiple Organ Dysfunction Syndrome (MODS). Case report. Special Journal of the Medical Academy and Other Life Sciences., 3(3). https://doi.org/10.58676/sjmas.v3i3.115

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