The role of point-of-care testing in the early diagnosis of pseudo-hypoxemia in myeloproliferative disorders

The diagnosis and management of hypoxemic respiratory failure is part of the daily routine of anesthesiologists, intensivists, and respiratory therapists. However, identification of some pathological states can be challenging, and failure to rapidly diagnose them can lead to inappropriate therapeutic decisions with expensive and potentially severe adverse consequences. These decisions can range from unnecessary intubation and mechanical ventilation to inappropriate administration of bicarbonate for false acidosis and consequent worsening of any existing metabolic abnormality. Additionally, performing unnecessary tests, such as computerized tomographic angiography to rule out pulmonary embolism, may negatively affect the kidneys, due to the intravenous iodine contrast. We report the case of a patient with hyperleukocytosis secondary to myelofibrosis who presented with altered mental status and pseudo-hypoxemia. We discuss the differential diagnoses of hypoxemia in this setting and the role of point-of-care arterial blood gas (ABG) analysis in diagnosing pseudohypoxemia.