{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T10:45:35Z","timestamp":1791801935159,"version":"4.3.4"},"reference-count":38,"publisher":"Walter de Gruyter GmbH","license":[{"start":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T00:00:00Z","timestamp":1791763200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"j_cclm-2026-1313_abs_001\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>\n                      Spurious hypoxemia\u00a0\u2013\u00a0a low PaO\n                      <jats:sub>2<\/jats:sub>\n                      with preserved, directly measured oxyhemoglobin saturation (sO\n                      <jats:sub>2<\/jats:sub>\n                      )\u00a0\u2013\u00a0is traditionally attributed to extreme leukocytosis or thrombocytosis (\u201cleukocyte larceny\u201d). We assessed how often it instead reflects PaO\n                      <jats:sub>2<\/jats:sub>\n                      temperature reporting or neonatal fetal-hemoglobin physiology.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_cclm-2026-1313_abs_002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We retrospectively analyzed 7,473 arterial blood-gas specimens from 2,647 patients (September 2020\u2013January 2026) with co-oximetry-derived sO\n                      <jats:sub>2<\/jats:sub>\n                      , complete blood count, and metabolic panel data; regression analyses used the 7,431 specimens reported within 80\u202fmin of collection. Spurious hypoxemia was defined as PaO\n                      <jats:sub>2<\/jats:sub>\n                      &lt;60\u202ftorr (8.0\u202fkPa) referenced to 37\u202f\u00b0C at measured pH, with sO\n                      <jats:sub>2<\/jats:sub>\n                      \u226592\u202f%. Firth logistic regression, Kaplan\u2013Meier analysis, and receiver-operating-characteristic curves evaluated temperature correction, neonatal status, and extreme leukocytosis (\u226550\u00a0\u00d7\u00a010\n                      <jats:sup>9<\/jats:sup>\n                      \/L) or thrombocytosis (\u2265500\u00a0\u00d7\u00a010\n                      <jats:sup>9<\/jats:sup>\n                      \/L).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_cclm-2026-1313_abs_003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Spurious hypoxemia affected 74 specimens (1.0\u202f%). Among hypothermic specimens, the apparent rate fell from 3.5\u202f% with PaO\n                      <jats:sub>2<\/jats:sub>\n                      reported at patient temperature to 0.9\u202f% when referenced to 37\u202f\u00b0C. Rates were higher in normothermic infants than adults (5.4 vs. 0.3\u202f%), consistent with fetal hemoglobin. Extreme leukocytosis was associated with the outcome (adjusted odds ratio 20.2; 95\u202f% confidence interval 5.6\u201360.9), but all four events occurred in neonates. Longer collection-to-reporting time was modestly associated (odds ratio 1.45 per 10\u00a0min), mainly in neonates. No non-neonatal specimen with a white-cell count \u226530\u00a0\u00d7\u00a010\n                      <jats:sup>9<\/jats:sup>\n                      \/L met the outcome (0\/139), and extreme thrombocytosis showed no association (0\/126).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_cclm-2026-1313_abs_004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      Apparent spurious hypoxemia was more often explained by temperature reporting and fetal hemoglobin than oxygen metabolism by leukocytes; the leukocytosis signal could not be separated from neonatal physiology. Laboratories should identify the PaO\n                      <jats:sub>2<\/jats:sub>\n                      reporting temperature, and clinicians should consider fetal-hemoglobin physiology before invoking leukocyte-mediated hypoxemia in neonates.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1515\/cclm-2026-1313","type":"journal-article","created":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T09:56:32Z","timestamp":1791798992000},"source":"Crossref","is-referenced-by-count":0,"title":["Low PaO\n                    <sub>2<\/sub>\n                    with normal saturation: beyond leukocyte-mediated hypoxemia"],"prefix":"10.1515","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4473-1601","authenticated-orcid":false,"given":"Gerald S.","family":"Zavorsky","sequence":"first","affiliation":[{"name":"Department of Physiology and Membrane Biology, University of California, Davis , Davis , CA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-1712-4814","authenticated-orcid":false,"given":"Kaila A.","family":"Labrador","sequence":"additional","affiliation":[{"name":"UC Davis School of Medicine, Sacramento , CA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2026,10,12]]},"reference":[{"key":"2026101209562937226_j_cclm-2026-1313_ref_001","doi-asserted-by":"crossref","unstructured":"Lele, AV, Mirski, MA, Stevens, RD. 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