It has been shown that patients with HS have a subpopulation of spherocytes with greatly impaired gas exchange, primarily owing to increased diffusion pathlength. Other factors include:
- Increased Hb crowding (MCHC)
- Reduced surface area: volume ratio
These slowly exchanging spherocytes are accentuated in the compensated state (talk about a trade-off!). These findings raise interesting questions about how splenectomy affects gas handling by RBCs in HS.