Effect of blood in the gut on measurements of endogenous carbon monoxide production

Changes induced in measurements of endogenous carbon monoxide (CO) production by blood in the lumen of the gut were studied in five normal volunteers. The study was undertaken because exogenous heme is absorbed by intestinal mucosal cells where the porphyrin ring is split with the release of CO that could contribute to blood CO levels and lead to a fallacious diagnosis of hemolytic disease. Volunteers who consumed 200 ml of their own blood doubled their endogenous production of CO (0.69 versus 0.34 mumoles/kg/hr). This suggested that at least 3% of the ingested heme was degraded and recovered as CO within 2 1/2 hr. Measurements of serum bilirubin also showed a significant increase after ingestion of blood. These data indicate that blood in the gastrointestinal tract can interfere with quantification of heme and bilirubin turnover from measurements of either endogenous CO production or bilirubin and suggest that this might occur with the ingestion of meat.