AMER. ZOOL., 20:163-172 (1980) Adaptation of Red Blood Cell Function to Hypoxia and Temperature in Ectothermic Vertebrates1 STEPHEN C. WOOD Department of Physiology, University of New Mexico, School of Medicine, Albttquerque, New Mexico 87131 INTRODUCTION The main purpose of this paper is to review the role of red cell metabolism and function in adaptations of ectothermic vertebrates to hypoxia and temperature. The term adaptation, as used in this article, means an alteration of physiological function which compensates for a stressful environmental or organismic factor. Two such factors of paramount importance to ectothermic vertebrates are temperature and oxygen availability. The physiological function to be examined in terms of adaptability is oxygen transport by blood from the gas exchange surface to the intracellular sites of O2 utilization. Hypoxia is best denned as inadequate uptake of O2 by tissues. The cause may be environmental (reduced O2 content and/or partial pressure in the respiratory medium) or organismic. In the latter category there is a hierarchy of sub-causes proceeding down the "oxygen cascade," i.e., impaired gas exchange, shunt, ventilation/ perfusion mismatch, hypoperfusion, or inappropriate oxygen binding properties of blood. The "appropriateness" of the oxygen binding properties of blood depends, in turn, on environmental conditions, i.e., the partial pressure of O2 (Po2) in the respiratory medium, and on the efficacy of gas exchange and degree of shunt. The position of the oxyhemoglobin dissociation curve (ODC) even with full knowledge about the environmental oxygen availability, is inadequate information for conclusions about adaptability of "appropriateness" for tissue oxygenation. Such conclusions are valid only if information is available on in vivo values of tem- perature, blood gases (arterial and mixed venous Po2 and Pco2), pH and oxygen capacity. Furthermore, the position of the ODC may cause, as well as be affected by, hypoxia. For example, in vertebrates with incompletely separated pulmonary and systemic circulations (lungfishes, amphibians, and reptiles), the arterial hypoxemia due to right-to-left shunting may lead to severe arterial desaturation and hypoxia if the ODC is positioned too far to the right. Conversely, hypoxia caused by environmental factors can, by influencing the aerobic metabolism of nucleated red cells (or anaerobic metabolism of mammalian red cells), alter (in opposite directions!) the level of allosteric effectors of hemoglobin function and shift the position of the ODC. Thus, although it is often irresistably tempting (as evidenced below) to assess physiological meaning from shapes and positions of ODCs, Bohr factors, and apparent enthalpy (AH) values, such speculations should always be recognized and identified as just that. INTERACTION OF TEMPERATURE AND HYPOXIA In ectotherms, the obligatory coupling of tissue temperature and oxygen demand is, for acute changes in temperature, predictable and well understood. Much less predictable and poorly understood is the relationship between temperature and hypoxia. While it is obvious that increased body temperature may tax the capacity of the oxygen transport system resulting in hypoxia, it is also possible for decreased body temperature to cause hypoxia. For example, if the organismic factors which determine the rate of oxygen transport 1 From the Symposium on Respiratory Pigments pre- down the "O cascade" have a temperature 2 sented at the Annual Meeting of the American Society of Zoologists, 27-30 December 1978, at Rich- coefficient less than that of metabolism, an increase in body temperature will cause mond, Virginia. 163 164 STEPHEN C. WOOD hypoxia. Conversely, if the Q10 of oxygen Physiological significance of transport is greater than that of metabo- AH in homeotherms lism, a decrease in body temperature will The temperature sensitivity of hemoglocause hypoxia. Of the four steps in the "O2 bin-oxygen affinity is an easily understood cascade,"2 it is the ultimate process, i.e., and measurable phenomenon. However, diffusion of oxygen from capillaries to cel- the link between biochemistry and physilular sites of utilization that is dependent ology is more difficult to assess, especially on the position and shape of the ODC. if body temperatures encompass a wide The adaptability of oxygen affinity, hemo- range (see below). For homeotherms, the globin subunit cooperativity, and oxygen problems of assessing the physiological imcapacity of blood to environmental and portance of AH are minimal due to the organismic factors is a major ingredient in small range of body temperature and the the evolutionary success of ectotherms. availability of data on in vivo blood gases and pH. Some recent data to assess the classical ADAPTATIONS TO TEMPERATURE view that the right-shifted ODC due to the Physical principles hyperthermia (and lactic acidemia) of The combination of oxygen molecules heavy exercise is adaptive in increasing tiswith hemoglobin is accompanied by a re- sue O2 uptake was provided by Thomson lease of heat. It follows (Le Chatelier prin- et al. (1978). They found that the femoral ciple) that an increase in blood tempera- blood in heavily exercising men had a pH ture will decrease the oxygen affinity of of 7.27 and a temperature of 40.7. Garby and Meldon (1977) applied these data to hemoglobin. When the temperature of hemoglobin is their mathematical model of tissue oxyraised, the increase in Po2 at constant sat- genation during exercise and found that uration (right-shifted ODC) is a function the combined effects of acidosis and temof the heat of combination of oxygen with perature (yielding a P50 of 38 torr comhemoglobin (AHo^). The general form of pared with ca. 26 torr for resting individthe van't Hoff isochore is d In K/dT = AH/ uals) would allow the required blood flow RT2. For oxygen binding by hemoglobin to be 49 ml/100 g/min as opposed to 82 if the equilibrium constant, K, is equivalent there were no shift in the ODC. It would to P50 (Hill equation) and the above equa- be very interesting to study the signifition can be restated as d log Po2/d (1/T) = cance of temperature on oxygen delivery AH/2.303 R. (R is the gas constant, 1.987 in mammals such as desert ungulates where core body temperature may incal/°K/mole.) This relationship between temperature crease by almost 5° during running (Tayand oxygen affinity of blood was first de- lor and Lyman, 1972). scribed by Barcroft and Hill (1909) and the nature of the bond between heme iron and Physiological significance of oxygen is such that little or no interspecies A// in ectotherms variation should occur in temperature senTemperature has a dual action on the sitivity of hemoglobin (cf., Klotz and Klotz, oxygen affinity of blood: the direct effect 1955). This is generally true for homeo- described above and an indirect effect therms, i.e., the AH of mammalian hemo- caused by the temperature-induced globins falls within the range of —9 to —14 changes in blood pH. Anaerobic changes kcal/mole (Rossi-Fanelli et al., 1964). How- in blood temperature cause the blood pH ever, as discussed in the following sections, to change by approximately -0.014 u/°C. there are some interesting exceptions This has striking consequences even in hoamong ectothermic vertebrates. meotherms when core temperature arterial blood perfuses peripheral tissues operating at other than core temperature. 2 (1) convection of the respiratory medium, (2) diffusion across the gas exchange surface, (3) convection Reeves (1976) calculated that the pH of arterial blood would increase to 7.67 in of blood, (4) diffusion into cells. ADAPTATIONS OF RED CELLS TO HYPOXIA AND TEMPERATURE 165 1.6 cooled skin capillaries and decrease to 7.35 \Rajo in exercising (42°C) muscle capillaries. He Neoceratodus^. points out that this change in pH with tem1.4 perature, parallel to the change in pH of neutral water, results in a constant charge 1.2 state on proteins and, presumably, provides for enzymatic activity which is temperature independent. This phenomenon is of greater significance in ectotherms where in addition to Q-° 08 regional differences in body temperature, Hb-Solution core temperature may vary daily by as O.4%,noDPG 06 much as 20-30°C. If both the temperature (AH) and proton sensitivity of ectotherm 0.4 hemoglobin have high values, the dual effects of temperature can easily shift the Q2 position of the ODC so much that oxygen delivery is affected out of proportion to 3.1 3.2 3.3 3.4 3.5 3.6 3.7 oxygen uptake. Adaptations of metabolic I/Absolute Temperature X IO3 rate were once described as allowing ec403735 30 25 20 15 10 5 0 totherms to "escape from the tyranny of Temperature °C the Arrhenius equation" (Barcroft, 1934). The following sections consider some anal- FIG. 1. Effect of temperature on the oxygen affinity purified human hemoglobin A and hemoglobin ogous and some different strategies allow- of from several species of fish. (Reprinted from K. Joing hemoglobin function a similar "escape." hansen and C. Lenfant, In Alfred Benzon Sympo- f '° Hemoglobins with a reduced A//: Strategy I The "strategy"3 of temperature adaptation which employs hemoglobin (or hemoglobin components) with reduced apparent AH values was first described in fish. As shown in Figure 1, the most dramatic reduction in temperature sensitivity occurs with tuna hemoglobin (AH = 1 . 8 kcal/ mole). The fascinating ability of the tuna to maintain a large core to peripheral temperature gradient (Carey and Teal, 1966) has prompted some novel speculation concerning the functional significance of the low AH. Hochachka and Somero (1973) suggest that if tuna hemoglobin had a normal AH, the cool peripheral blood entering the warm, deep muscles might unload oxygen so rapidly as to produce gas emboli. Since the large temperature gradient only develops during active swimming, this 3 To those who would object to the term "strategy" on the basis that it implies some divine (or otherwise) inspiration, I plead its acceptability on the basis of the thoughtful descriptions of "strategies" of adaptation by Hochachka and Somero (1973). sium IV, Oxygen Affinity of Hemoglobin and Red Cell Acid-Base Status. Copenhagen, Munksgaard 1972, with permission of the publisher.) theory would be difficult to test. Also, the original data on the AH of tuna hemoglobin was obtained from hemolysates (RossiFanelli and Antonini, 1960). It would be more relevant to know the AH of whole blood which, as discussed below, would probably be even lower than —1.8 kcal/ mole. A variation on this theme of adaptation occurs in some fishes with multiple hemoglobins. Chum salmon, for example, have two hemoglobin components, one with a normal and the other with reduced sensitivity to temperature and pH (Hashimoto, 1960). Some reasonable speculations about the significance of this suggest homeostasis of oxygen delivery during periods of fluctuating body temperature (Johansen and Weber, 1976). As body temperature increased, the beneficial effect of augmented oxygen unloading could be provided by the temperature sensitive hemoglobin, while the temperature insensitive hemoglobin would assure continued oxygen 166 STEPHEN C. WOOD 1.4 Hb Solution 0.4% 1.2 Ictalurus Nebulosus (whole blood) _ (e.g., Amia) is that higher body temperatures induce air breathing. When this happens, the higher AH is advantageous in shifting the ODC into a range of Po2 values more appropriate for air breathing (Johansen et al., 1970; Johansen and Lenfant, 1972). Amia Colvo (whole blood) 1.0 mM OPG v 1.0 20° c \ 0.8 24»C Q6 Mechanism of reduced values of AH 0.4 0.2 3.3 3.4 3 5 3 6 3.3 3 4 3 5 3 6 3 3 3.4 35 36 I/Absolute Temperature X I 0 3 FIG. 2. Left, panel: Effect of DPC on the oxygen affinity and temperature sensitivity of stripped human hemoglobin A. Middle and right panels: Temperature-induced changes in the oxygen affinity of fish whole blood. Note that the in vivo change in P50 in acclimated fish (lines connecting the two temperature curves) is much less than the in vitro temperature sensitivity of blood. (Reprinted from K. Johansen and C. Lenfant, In Alfred Benzon Symposium IV, Oxygen Affinity of Hemoglobin and Red Cell Acid-Base Status. Edited by M. Rj?frih and P. Astrup. Copenhagen, Munksgaard, 1972, with permission of the publisher.) Since the intrinsic properties of hemoglobin-oxygen interaction dictate a constant and relatively high AH, observed deviations of the AH of blood from that of purified hemoglobin solutions must reflect additive or subtractive, and usually pH dependent, interaction of hemoglobin with intracellular ligands other than oxygen. Of particular importance is the effect of organic phosphates on the apparent AH of oxygen binding. As shown in Figure 2, the presence of 2,3 DPG reduces the temperature sensitivity of oxygen binding. This occurs because the binding of oxygen and 2,3 DPG are both exothermic reactions. Since oxygenation of hemoglobin in the presence of 2,3 DPG produces displacement of 2,3 DPG, the absorption of heat from 2,3 DPG displacement is subtracted from the release of heat from oxygen uptake and the apparent AH is decreased from -10.7 kcal/mole (no DPG) to - 7 . 3 kcal/mole (DPG). Benesch et al. (1969) speculated that the low AH of tuna hemoglobin may result from interaction with some cofactor which is bound with a AH very close to that of oxygen. If this were true, then the AH of tuna hemoglobin should increase when purified solutions instead of hemolysates are examined. To the author's knowledge, this has not been done with tuna hemoglobin. However, Powers et al. (1979) have shown that species difference in the thermal sensitivity of oxygen binding by fish blood are due only to differences in intracellular pH, organic phosphates, and other ligands. They found no species differences in the intrinsic thermodynamic properties of fish hemoglobins. loading at the gills. It would be very interesting to experimentally test this idea. If the P50 = f (temp) curves intersect in the physiological range, then, at the temperature of intersection, the fish has only one operational ODC. At a higher body temperature, the temperature-sensitive hemoglobin would have a lower oxygen affinity than the temperature-insensitive hemoglobin. However, at a body temperature lower than the point of intersection of the P50 = f (temp) curves, the reverse would be true. Thus, the operational site of both the temperature sensitivity and Bohr effect could switch between the lungs and tissues at different body temperatures. The other species in Figure 1 illustrate the trend of higher apparent AH values in stenothermal species. For example, the African lungfish Protopterus experiences minimal changes in body temperature and has hemoglobin with a high AH. Conversely, the Australian lungfish, Neoceratodus, is There is, however, some evidence for a eurythermal and has a low AH. An addi- reduced intrinsic enthalpy of hemoglobin. tional factor applicable to Protopterus and Barra et al. (1973) showed that one hemoother species capable of bimodal breathing globin component in trout which, even 167 ADAPTATIONS OF RED CELLS TO HYPOXIA AND TEMPERATURE when purified, has a reduced AH, has a number of amino acid substitutions involving the loss of histidine. This could provide a molecular mechanism for the reduced AH since the loss of histidines would reduce the enthalpic contributions of the Bohr effect to normal temperature sensitivity. The loss of histidines also accounts for the reduced proton sensitivity of this trout hemoglobin. Reduced AH values in reptiles: A case study The available data on AH of reptilian blood does not support the generalization that stenothermal species show a higher AH than eurythermal species. In fact, the reverse seems to be the case (cf., Pough, 1980) when large scale species comparisons are made. However, for one eurythermal species which does have a low AH, in vivo data are available to assess the significance of AH to oxygen transport. This is the common iguana in which the AH of whole blood is - 3 kcal/mole (Wood and Moberly, 1970). Figure 3 shows the physiological range of ODCs in the iguana. Blood pH in the iguana, as in most other reptiles, is inversely related to body temperature. At a body temperature of 20° the P50 of blood is 20 torr at the in vivo blood pH of 7.7. Body temperature routinely increases to 37°C when iguanas bask in the sun. At this temperature, if the AH of iguana blood were — 13 kcal/mole the P50 of blood would increase to ca. 51 torr due to temperature alone, i.e., at pH 7.7. However, iguana blood has an in vivo temperature coefficient of d P H / d T = -0.018 u/°C. So at 37°C, arterial pH would be decreased from 7.7 to 7.4. The Bohr factor of iguana blood is -0.52 d log P-Jd pH (Wood and Moberly, 1970). This would augment the right shift of the ODC so that at 37°C and pH 7.4, the P5() of blood would be 73 torr. As shown in Figure 3, this P50 would be only 7 torr below arterial Po2 and arterial saturation could at best be about 70%. However, when the actual AH of iguana blood is applied to the above example, the P50 is found to increase to 54 instead of 73 torr and arterial blood is almost fully saturated. 1001 90 eo 70 30 40 50 60 70 P02 . mm Hg 90 100 110 Fic. 3. Oxygen dissociation curves of iguana blood at in vivo values of temperature and pH during heating and cooling. Curves drawn from data of Wood and Moberly, 1970. Arterial Po2 value from W. R. Moberly, unpublished. It could also be argued that the above potential problem would be alleviated by a reduced Bohr factor. This is true, but may be a less desirable strategy for a diving animal, like the iguana, in which the large Bohr factor assures effective utilization of the blood oxygen store (cf., Wood and Lenfant, 1976). Temperature acclimation of oxygen affinity: Strategy II A reduced value of AH may be beneficial in reducing the potentially harmful effects of rapid changes in body temperature or rapid changes in blood temperature in flowing from cool to warm tissues. For longer term temperature changes, there are numerous examples where hemoglobin function shows a type of adaptation analogous to that of metabolic rate, i.e., a rotation or parallel displacement of the P50 = f (temp) curve. The latter type of acclimation has been described most often. In this case the seasonal, or long-term, change in oxygen affinity with temperature is much less than the acutely measured AH for either acclimation group (cf, Figs. 2 and 4). This has been described for the frog, Rana esculenta (Kirberger, 1953; Straub, 1957; Gahlenbeck and Bartels, 1968), the fishes, Ictalurus nebulosus (Grigg, 1969), Amia calva (Johansen and Lenfant, 1972), Carassius auratus (Vaccaro 168 STEPHEN C. WOOD 100 pH 764( warm acclim 50 20 30 Temperoture,°C 40 Malacochersus tornicri 10 30 50 70 90 110 Po2 (mmHg) Fir.. 4. Oxygen dissociation curves of warm and cold acclimated tortoises measured at 20° and 35°C at in vivo values of blood pH. Insert shows effect of acclimation on reducing the effects of temperature on P5(, (dashed line). Data from Wood et ai, 1977. et al., 1975), and a tortoise, Malacochersus tornieri (Wood et al., 1978). have, or should have, been investigated: 1. A change in the distribution of multiple hemoglobin components. This was ruled out in the cases of Ictalurus and Carassius. 2. A change in the intracellular (RBC) concentration of chloride or other diffusible ions known to affect hemoglobin-oxygen affinity, e.g., H + , Mg ++ . This has not, to my knowledge, been investigated. However, for species which show an inverse relationship of blood Mechanism of temperature acclimation of pH and temperature, there should be oxygen affinity no significant changes in the Donnan distribution of ions since net protein The following potential mechanisms of change remains constant (Reeves, 1976). thermal acclimation of oxygen affinity In all of the above studies, the ODC of cold acclimated animals was shifted to the right when compared with that of warm acclimated animals at the same temperature and pH. Consequently, as shown in Figures 2 and 4, the AH after thermal acclimation is considerably less than the in vitro or short-term in vivo AH for these species. ADAPTATIONS OF RED CELLS TO HYPOXIA AND TEMPERATURE ACUTE HYPOXIC HYPOXIA 169 CHRONIC HYPOXIC HYPOXIA T T Increased blood pH (hyperventilation) Increased HHb/HbO2 ratio Altered Donnan distribution "of H+ ions Increased red cellpH- Decreased red cell Inhibition"^ DPG Phosphtase p-EFT-SHIFTED ODC | Activation of DPG Mutase jncreased2,3DPG Concentration Altered Donnan distribution" of H+ions • I RIGHT-SHIFTED ODCl Fie. 5. Mechanisms controlling 2,3-DPG metabolism and hemoglobin oxygen affinity of human red blood cells during hypoxia. (Modified from E. Gerlach and J. Duhm, 2,3-DPG metabolism of red cells: Regulation and adaptive changes during hypoxia. In Alfred Benzon Symposium IV, Oxygen Affinity of Hemoglobin and Red Cell Acid-Base Status. Edited by M. Rfinh and P. Astrup. Copenhagen, Munksgaard, 1972, with permission from the publisher.) 3. A change in the concentration or effectiveness of organic phosphate modulators of oxygen affinity. In the study of Grigg (1969), he ruled out differences in oxygen affinity due to altered hemoglobin components. Also, since purified hemoglobins from both acclimation groups had the same oxygen affinity, changes in intrinsic oxygen affinity were excluded. Organic phosphates do not seem to be involved in the temperature acclimation of Amia or Carassius but are known to change during thermal acclimation of other fishes (Powers, 1974). In the tortoise, an increase in red cell ATP accounts for the right-shifted curve of cold acclimated animals. The physiological significance of this pattern of temperature acclimation has yet to be determined. It is, of course, tempting to speculate that since this pattern of acclimation is analogous to that observed for oxygen demand, there is some functional link. The experiment which remains to be done is to measure oxygen delivery to the tissues of cold acclimated animals and the question: is the right-shifted ODC following cold acclimation adaptive to the increase (over acute exposure) in oxygen demand? ADAPTATIONS TO HYPOXIA Hypoxia is a frequent or continuous problem for many ectotherms, especially aquatic species. The problem is accentuated in water breathers because of the low oxygen content of water relative to air. Also, a ventilatory response to hypoxia is largely precluded because of the excessive work of breathing. Adaptations of erythrocyte function to hypoxia were, until the late 1960s, thought to be limited to increases in O2 carrying capacity due to increases in red cell mass. The demonstration by Benesch and Benesch (1967) and Chanutin and Curnish (1967) of the allosteric effects of organic phosphates on human hemoglobin stimulated a great deal of research on this aspect of metabolism and function in mammalian red cells (cf., Bunn, 1980). The types of organic phosphates in vertebrate red blood cells were described long before the 170 S T E P H E N C. WOOD -HYPOXIC HYPOXIAChronic Acute Decreased red cell ATP Increased blood pH I LEFT-SHIFTED ODCl Altered Donnan J Increased Hb/HbO 2 ratio Increased red cell pH Fie. 6. Mechanisms controlling ATP concentration and oxygen affinity of nucleated red blood cells. From Wood and Lenfant, 1979. functional significance was appreciated (Rapoport and Guest, 1941) and current data on organic phosphate distribution is presented elsewhere (cf., Bartlett, 1980). For present purposes, I will consider two important features of organic phosphates in ectotherm erythrocytes. First, is the fact that oxidative phosphorylation is the primary source of most organic phosphates in the nucleated red cells of non-mammalian vertebrates. Thus, in contrast to 2,3 DPG in mammals, the synthesis of allosteric effectors in nucleated red cells is oxygen dependent. Second, is the fact that organic phosphates have, in all red cells, an indirect (non-allosteric) effect on hemoglobin function. This results from their effect, as non-diffusible anions, on the Donnan distribution of hydrogen ions and intracellular pH. In mammals, as shown in Figure 5, the initial effect of hypoxia is an increase in both plasma pH (from hyperventilation) and red cell pH. This stimulates phosphofructokinase which increases glycolytic rate and DPG mutase which increases 2,3 DPG synthesis. Noteworthy features of this regulatory pattern are the negative feedback control of red cell pH and the fact that the two effects of pH on Hb-O 2 affinity tend to offset each other. The Bohr effect tends to move the ODC to the left during alkalosis while the alkalosis-induced increase in 2,3 DPG tends to move the ODC to the right. Consequently, the in vivo curve in acute high altitude exposure may be unchanged from the sea level curve. In nucleated red cells (Fig. 6) a decrease in organic phosphates occurs during hypoxia, at least in the case of ATP. In contrast to mammalian red cells, the acid-base and organic phosphate changes induced by hypoxia have complementary effects on the oxygen affinity of nucleated red cells (see below). GTP is synthesized in the Kreb's cycle and its metabolic control may be independent from ATP production. In some fish species, GTP has been shown to be more important than ATP in regulating Hb-O2 affinity (Weber et al., 1976) and, although ATP must be reduced during hypoxic conditions, it seems that GTP may be regulated enzymatically in a manner analogous to DPG. A change in the concentration of organic phosphate has two effects which work in concert to alter oxygen affinity of hemoglobin. By binding to deoxygenated hemoglobin, the direct or allosteric effect is produced. Also, a change in organic phosphate concentration affects the Donnan equilibrium of ions (including H+) across the cell membrane resulting in a Bohr shift of the ODC. The relative contributions of these two effects to the displacement of the ODC depend primarily on the level of plasma pH. As shown in Figure 7, at high values of plasma pH, the indirect effect of organic phosphate is more important. In poikilotherms, this is often the physiological pH range (Duhm, 1971; Wood and Johansen, 1973). The paradox that both an increase and a decrease in red cell organic phosphates ADAPTATIONS OF RED CELLS TO HYPOXIA AND TEMPERATURE 171 IOOI I 6.6 6.8 7.0 7.2 7.4 7.6 78 8.0 plasmo pH (pHe) Q '0 10 20 30 40 Po2 , torr 50 60 70 FIG. 7. Oxygen dissociation curves of control and hypoxia adapted eels at 20° and in vivo values of extracellular and intracellular pH. As shown in the insert, the decreased ATP concentration in hypoxic eels causes a net efflux of H + ions and a higher intracellular pH than control eels at the same extracellular pH. Data from Wood and Johansen, 1972 and 19736. REFERENCES can be adaptive to hypoxia is resolved when the degrees of hypoxia experienced Barcroft, J. 1934. Features in the architecture of physiological function. Cambridge University by different vertebrates are considered. As Press. discussed earlier, it is the degree of hypox- Barcroft, J. and W. O. R. King. 1909. The effect of ia which determines the usefulness of a left temperature on the dissociation curve of blood. versus a right shift of the ODC. In severe J. Physiol. (London) 39:374-384. hypoxia, a left shift proves to be advanta- Barra, D., F. Bossa, J. Bonaventura, and M. Brunori. 1973. 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