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2,3-Diphosphoglycerate Test

2,3-Diphosphoglycerate Test


2,3-diphosphoglycerate (2,3-DPG) is a substance made in the red blood cells. It controls the movement of oxygen from red blood cells to body tissues. 2,3-DPG testing is done to help investigate both a deficiency in red blood cells (anemia) and an unexplained increase of red blood cells, called erythrocytosis.


Hemoglobin, the protein in the blood that carries oxygen, uses 2,3-DPG to control how much oxygen is released once the blood gets out into the tissues. The more 2,3-DPG in the cell, the more oxygen is delivered to body tissues. Conversely, the less 2,3-DPG in the cell, the less oxygen is delivered.

Increasing the amount of 2,3-DPG is the body's primary way of responding to a lack of oxygen. Anemia, obstructive lung disease, cystic fibrosis, and congenital heart disease are all accompanied by increases in 2,3-DPG. When more oxygen is required because of increased metabolism, such as in hyperthyroidism, more 2,3-DPG is produced.

Decreased 2,3-DPG results from an inherited lack of the red blood cell enzymes 2,3-DPG mutase and 2,3-DPG phosphatase. These enzymes are needed to make 2,3-DPG. Without 2,3-DPG to control the movement of oxygen to its tissues, the body responds by making more red blood cells, a condition called erythrocytosis. The outside membrane of the cell is weakened, causing it to have an irregular shape and burst, or hemolyze, easily. This condition is called nonspherocytic hemolytic anemia.

2,3-DPG levels are important in large blood transfusions, because stored blood quickly loses 2,3-DPG and its ability to deliver oxygen. After transfusion, the red cells rebuild the 2,3-DPG, but it takes about 24 hours to regain a normal level of 2,3-DPG and hemoglobin function.


In the laboratory, a person's serum is mixed with a substance that will react with 2,3-DPG. The end product of this reaction is measured; and from that measurement, the amount of 2,3-DPG in the person's serum is determined. Results are usually available the next day.


This test requires drawing 5-10 mL of blood. The patient should not exercise before having the blood drawn. Exercise increases the body's need for oxygen and could cause a temporary increase in levels of 2,3-DPG.


Discomfort or bruising may occur at the puncture site, or the person may feel dizzy or faint. Pressure to the puncture site until the bleeding stops will reduce bruising. Warm packs to the puncture site will relieve discomfort.

Normal results

Normal results will vary based on the laboratory and testing methods used.

Abnormal results

Decreased levels of 2,3-DPG are found in cases of erythrocytosis and nonspherocytic hemolytic anemia caused by 2,3-DPG mutase and 2,3-DPG phosphatase deficiencies. Lower levels are also commonly found after large blood transfusions.

Increased levels of 2,3-DPG are found in conditions in which the body needs more oxygen, such as anemia, obstructive lung disease, cystic fibrosis, congenital heart disease, and hyperthyroidism. High altitudes and participating in exercise sessions before the test can also give false high values.



Hsia, Connie C. W. "Respiratory Function of Hemoglobin." New England Journal of Medicine 338 (January 1998): 239-247.


Anemia A reduction in the number of erythrocytes or red blood cells. Erythrocytes are necessary to form hemoglobin for transporting oxygen.

Erythrocytosis Increased production of red blood cells.

Hemoglobin A protein within the red blood cell that carries oxygen.

Nonspherocytic hemolytic anemia Anemia caused by variably shaped red blood cells that burst, or hemolyze, easily.

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