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Co-oximetry determines hemoglobin composition using optical measurements at multiple wavelengths. In a laboratory blood analyzer, it can distinguish oxyhemoglobin, deoxyhemoglobin, carboxyhemoglobin and methemoglobin rather than infer all hemoglobin behavior from a single oxygen-related number. A manufacturer description explicitly identifies direct optical spectrophotometry as the measurement method for its analyzer's co-oximetry parameters.^[ref]

An idealized mixture model makes the separating information explicit:where $A_j$ is measured absorbance, $\ell$ the path length, $c_i$ a species concentration, ${\epsilon }_i$ its molar absorption coefficient and $b_j$ a background term. Estimating four unconstrained concentrations requires sufficient independent spectral observations and known response coefficients; merely having four wavelength labels does not guarantee independence. An isosbestic point shared by two species supplies information about their combined amount but cannot by itself separate their proportions.

The denominator of a reported fraction matters. In a simplified four-form example, stipulate $90\%$ oxyhemoglobin, $5\%$ deoxyhemoglobin, $4\%$ carboxyhemoglobin and $1\%$ methemoglobin, all expressed on the same total-hemoglobin basis. Fractional oxyhemoglobin is $0.90$, but the functional oxygen saturation isThese differ because the second denominator excludes the other two forms. The manufacturer's parameter description distinguishes these definitions.^[ref] The chosen fractions are an explanatory example, not clinical thresholds.

A blood-sample optical assay and a noninvasive pulsatile optical measurement use different observation models. Their output labels and denominators must be established from the specific method, rather than inferred from the common word oximetry. Likewise, oxygen partial pressure describes dissolved oxygen equilibrium and is not itself a measurement of all hemoglobin fractions.

An instrument test can compare reference mixtures with independently established composition, record full spectral residuals and vary a suspected interferent. Agreement of one derived saturation number alone does not validate every inferred species concentration. Background, spectral overlap and sample handling belong in the measurement model and its uncertainty.

Deoxyhemoglobin is the unoxygenated form of hemoglobin whose available haem sites can reversibly bind oxygen. Releasing oxygen produces a binding-state change, rather than the ferric iron state defining methemoglobin. Carboxyhemoglobin differs again because a competing carbon monoxide ligand occupies a binding site. These distinctions matter when interpreting the components of an optical measurement.

In the instrument convention for functional oxygen saturation, HHb denotes the unoxygenated, oxygen-capable component. Its concentration appears with oxyhemoglobin in the denominator:The HHb label is not an instruction to treat deoxygenation as addition of a hydrogen molecule. Functional saturation also uses a different denominator from fractional oxyhemoglobin referenced to total hemoglobin.^[ref]

An original independent-site model illustrates a further counting distinction. Let each of four sites have oxygen-occupancy probability $\theta$, independently. The probability that a tetramer has exactly $m$ occupied sites isAt $\theta =1/2$, half the sites are empty on average, while only $P_0=1/16$ of tetramers have all four sites empty. A haem-equivalent unoxygenated fraction therefore need not equal the fraction of wholly unliganded tetramers. Real hemoglobin binding is cooperative, so independence here is a stated teaching assumption rather than a physiological model.

Deoxyhemoglobin and oxyhemoglobin have distinguishable absorption spectra. A primary study measured the absorptivities of these and other human hemoglobin derivatives across 450–1000 nm, including fetal/adult differences relevant to multicomponent analysis.^[ref] A controlled oxygenation comparison can therefore follow changing spectral contributions without inferring oxygen amount from apparent colour alone. The measured path length, concentrations and calibrated component spectra remain necessary inputs.

Fractional oxyhemoglobin is the oxyhemoglobin concentration divided by the concentration of all measured hemoglobin species in the same blood sample. With $H_O,H_D,H_C,H_M$ denoting oxyhemoglobin, deoxyhemoglobin, carboxyhemoglobin and methemoglobin concentrations, respectively,Additional measured hemoglobin species belong in the denominator when present. Functional oxygen saturation instead uses $H_O/(H_O+H_D)$. The distinction is the denominator, not whether the result is written as a fraction or a percentage.^[ref]

For a constructed mixture with concentrations proportional to $85,5,10,0$, respectively, fractional oxyhemoglobin is $85\%$, while functional oxygen saturation is $85/90\approx 94.4\%$. The second number excludes the carboxyhemoglobin from its denominator; it has not created additional oxygen-carrying oxyhemoglobin.

This distinction matters when converting hemoglobin measurements into arterial oxygen content. If $H$ is total hemoglobin concentration and $\beta$ is a stipulated oxygen-binding capacity per unit hemoglobin mass, the bound-oxygen term is $\beta H{F}_{{\mathrm{O}}_2\mathrm{Hb}}$. Choosing $H=15$ g/dL and $\beta =1.34$ mL/g in the example gives $17.085$ mL of bound oxygen per dL of blood. Substituting $85/90$ instead would give about $18.98$ mL/dL. This calculation isolates the denominator error; dissolved oxygen is a separate contribution. A measurement of oxygen saturation alone therefore does not determine total blood oxygen content.

Functional oxygen saturation is the fraction of the sum of oxyhemoglobin and deoxyhemoglobin that is present as oxyhemoglobin:Here $H_O$ and $H_D$ are the corresponding concentrations in the same blood sample. Carboxyhemoglobin and methemoglobin are excluded from this denominator. Fractional oxyhemoglobin instead divides by the total concentration of measured hemoglobin species.^[ref]

A constructed example shows what the exclusion does. If a sample contains 90 concentration units of oxyhemoglobin, 10 of deoxyhemoglobin and 25 of carboxyhemoglobin, its functional oxygen saturation is $90/(90+10)=0.90$. Its fractional oxyhemoglobin is $90/125=0.72$. Both values describe the same mixture, with different reference populations.

If $d$ denotes the fraction of total hemoglobin excluded from the functional denominator, thenThus knowing only $s_{{\mathrm{O}}_2}$ does not determine the oxygenated fraction of total hemoglobin unless $d$ is also known or negligible. In the example, $d=25/125=0.20$ and $0.90(1-0.20)=0.72$.

The distinction has an experimental consequence for co-oximetry. Optical analysis must distinguish the absorbing hemoglobin derivatives before calculating the desired ratio; changing the denominator of the displayed result does not change the blood sample. Total oxygen content additionally requires hemoglobin concentration and the dissolved oxygen contribution. Hemoglobin-concentration and saturation separation therefore remains necessary even when functional oxygen saturation has been measured accurately.

Hemoglobin-concentration and saturation separation is the distinction between how much hemoglobin a volume of blood contains and what fraction of its available oxygen-binding capacity is occupied. Oxygen saturation is a ratio; hemoglobin concentration is an amount per volume. Neither quantity alone specifies arterial oxygen content.

Let $H$ be total hemoglobin concentration, $F$ the fractional oxyhemoglobin and $\beta$ a chosen oxygen capacity per unit hemoglobin mass. A simple content model iswhere the final term represents dissolved oxygen using a solubility coefficient $\alpha$ and oxygen partial pressure $p_{{\mathrm{O}}_2}$. The model separates carrier amount, carrier occupancy and dissolved gas. Functional oxygen saturation can replace $F$ only when the excluded hemoglobin species are negligible or separately accounted for.^[ref][ref]

For an original comparison, neglect dissolved oxygen and stipulate $\beta =1.34$ mL/g and $F=0.98$. Samples with $H=15$ and $H=8$ g/dL then carry about $19.70$ and $10.51$ mL of bound oxygen per dL, respectively. The equal oxygen saturation does not imply equal oxygen content. Conversely, halving $H$ and doubling $F$ preserves the product $HF$ only while the new fraction remains physically attainable.

A primary instrument illustrates how the distinction can be measured rather than merely defined. In 1989, a capillary-tube oximeter used red and infrared light, a detector and digitized processing to derive hemoglobin concentration and oxygen saturation separately.^[ref] Measurements sensitive to different optical features supply information that one saturation number cannot contain. At fixed blood flow, oxygen delivery scales with content; equal saturation readings alone cannot establish equal delivery.