D_LCO or T_LCO ( diffusing capacity or transfer factor of the lung for

carbon monoxide Carbon monoxide (chemical formula CO) is a colorless, poisonous, odorless, tasteless, flammable gas that is slightly less dense than air. Carbon monoxide consists of one carbon atom and one oxygen atom connected by a triple bond. It is the simple ...

(CO),) is the extent to which oxygen passes from the

air sacs Air sacs are spaces within an organism where there is the constant presence of air. Among modern animals, birds possess the most air sacs (9–11), with their extinct dinosaurian relatives showing a great increase in the pneumatization (presence ...

of the

lungs The lungs are the primary organs of the respiratory system in humans and most other animals, including some snails and a small number of fish. In mammals and most other vertebrates, two lungs are located near the backbone on either side of th ...

into the

blood Blood is a body fluid in the circulatory system of humans and other vertebrates that delivers necessary substances such as nutrients and oxygen to the cells, and transports metabolic waste products away from those same cells. Blood in the c ...

. Commonly, it refers to the test used to determine this parameter. It was introduced in 1909.

Mechanism

This test involves measuring the

partial pressure In a mixture of gases, each constituent gas has a partial pressure which is the notional pressure of that constituent gas as if it alone occupied the entire volume of the original mixture at the same temperature. The total pressure of an ideal gas ...

difference between inspired and expired carbon monoxide. It relies on the strong affinity and large absorption capacity of

red blood cell Red blood cells (RBCs), also referred to as red cells, red blood corpuscles (in humans or other animals not having nucleus in red blood cells), haematids, erythroid cells or erythrocytes (from Greek ''erythros'' for "red" and ''kytos'' for "holl ...

s for carbon monoxide and thus demonstrates gas uptake by the capillaries that are less dependent on

cardiac output In cardiac physiology, cardiac output (CO), also known as heart output and often denoted by the symbols Q, \dot Q, or \dot Q_ , edited by Catherine E. Williamson, Phillip Bennett is the volumetric flow rate of the heart's pumping output: t ...

. The measurement of D_LCO is affected by atmospheric pressure and/or altitude and correction factors can be calculated using the method recommended by the American Thoracic Society. Expected D_LCO is also affected by the amount of hemoglobin,

carboxyhemoglobin Carboxyhemoglobin (carboxyhaemoglobin BrE) (symbol COHb or HbCO) is a stable complex of carbon monoxide and hemoglobin (Hb) that forms in red blood cells upon contact with carbon monoxide. Carboxyhemoglobin is often mistaken for the compound form ...

, age and sex. The correction for hemoglobin is based on the method of Cotes as recommended by the American Thoracic Society.

D_LCO vs T_LCO

Generally D_LCO is measured in "ml/min/

kPa KPA may refer to: * Keele Postgraduate Association, Keele University, UK, formerly Keele Research Association (KRA) * Kensington (Olympia) station, London, England, National Rail station code * Kenya Ports Authority * ''Kiln phosphoric acid'', a ...

" and T_LCO is measured in "mmol/min/kPa".

Factors affecting D_LCO

Decrease

D_LCO is decreased in any condition which affects the effective alveolar surface area: # Hindrance in the

alveolar Alveolus (; pl. alveoli, adj. alveolar) is a general anatomical term for a concave cavity or pit. Uses in anatomy and zoology * Pulmonary alveolus, an air sac in the lungs ** Alveolar cell or pneumocyte ** Alveolar duct ** Alveolar macrophage * ...

wall. e.g.

fibrosis Fibrosis, also known as fibrotic scarring, is a pathological wound healing in which connective tissue replaces normal parenchymal tissue to the extent that it goes unchecked, leading to considerable tissue remodelling and the formation of perma ...

, alveolitis,

vasculitis Vasculitis is a group of disorders that destroy blood vessels by inflammation. Both arteries and veins are affected. Lymphangitis (inflammation of lymphatic vessels) is sometimes considered a type of vasculitis. Vasculitis is primarily caused b ...

# Decrease of total lung area, e.g.

Restrictive lung disease Restrictive lung diseases are a category of extrapulmonary, pleural, or parenchymal respiratory diseases that restrict lung expansion, resulting in a decreased lung volume, an increased work of breathing, and inadequate ventilation and/or oxygenat ...

or lung resection (partial or total). #

Chronic obstructive pulmonary disease Chronic obstructive pulmonary disease (COPD) is a type of progressive lung disease characterized by long-term respiratory symptoms and airflow limitation. The main symptoms include shortness of breath and a cough, which may or may not produce ...

(Emphysema) due to decreased surface area in the alveoli, as well as damage to the capillary bed #

Pulmonary embolism Pulmonary embolism (PE) is a blockage of an pulmonary artery, artery in the lungs by a substance that has moved from elsewhere in the body through the bloodstream (embolism). Symptoms of a PE may include dyspnea, shortness of breath, chest pain p ...

# Cardiac insufficiency # Pulmonary hypertension #

Bleomycin -13- (1''H''-imidazol-5-yl)methyl9-hydroxy-5- 1''R'')-1-hydroxyethyl8,10-dimethyl-4,7,12,15-tetraoxo-3,6,11,14-tetraazapentadec-1-yl}-2,4'-bi-1,3-thiazol-4-yl)carbonyl]amino}propyl)(dimethyl)sulfonium , chemical_formula = , C=55 , H=84 , N=1 ...

(upon administration of more than 200 units) # Anemia-due to decrease in blood volume #

Amiodarone Amiodarone is an antiarrhythmic medication used to treat and prevent a number of types of cardiac dysrhythmias. This includes ventricular tachycardia (VT), ventricular fibrillation (VF), and wide complex tachycardia, as well as atrial fibrilla ...

high cumulative dose; more than 400 milligrams per day # After

chemotherapy Chemotherapy (often abbreviated to chemo and sometimes CTX or CTx) is a type of cancer treatment that uses one or more anti-cancer drugs (chemotherapeutic agents or alkylating agents) as part of a standardized chemotherapy regimen. Chemotherap ...

and

radiotherapy Radiation therapy or radiotherapy, often abbreviated RT, RTx, or XRT, is a therapy using ionizing radiation, generally provided as part of cancer treatment to control or kill malignant cells and normally delivered by a linear accelerator. Radia ...

However, many modern devices compensate for the

hemoglobin Hemoglobin (haemoglobin BrE) (from the Greek word αἷμα, ''haîma'' 'blood' + Latin ''globus'' 'ball, sphere' + ''-in'') (), abbreviated Hb or Hgb, is the iron-containing oxygen-transport metalloprotein present in red blood cells (erythrocyte ...

value of the patient (taken by blood test), and excludes it as a factor in the DLCO interpretation.

Increase

Factors that can increase the D_LCO include

polycythaemia Polycythemia (also known as polycythaemia) is a laboratory finding in which the hematocrit (the volume percentage of red blood cells in the blood) and/or hemoglobin concentration are increased in the blood. Polycythemia is sometimes called erythr ...

, asthma (can also have normal D_LCO) and increased pulmonary blood volume as occurs in exercise. Other factors are left to right intracardiac shunting, mild left heart failure (increased blood volume) and alveolar hemorrhage (increased blood available for which CO does not have to cross a barrier to enter).

Significance of results

There is no universally recognized reference value range for DLCO as of 2017, but values in the 80%-120% of predicted range based on instrument manufacturer standards are generally considered normal. A D_LCO of less than 60% predicted portends a poor prognosis for lung cancer resection. FEV₁ is of lesser prognostic value for lung resection survival.Diffusion lung capacity for carbon monoxide (DLCO) is an independent prognostic factor for long-term survival after curative lung resection for cancer (p n/a) Michael J. Liptay, Sanjib Basu, Michael C. Hoaglin, Neil Freedman, L. Penfield Faber, William H. Warren, Zane T. Hammoud, Anthony W. Kim. ''Journal of Surgical Oncology''. Published Online: Oct 1 2009 8:20AM

References

External links

* {{DEFAULTSORT:Dlco Diagnostic pulmonology Respiratory physiology