Acute haemolytic anaemia and myolysis due to G6PD deficiency

Abstract

A 2-year-old African-American male patient with sickle cell trait developed cough, red coloured urine, pallor and fatigue. The patient was hospitalised. Diagnostic workup showed that he was glucose 6 phosphate dehydrogenase (G6PD) deficient in erythrocytes. He also had chest X-ray findings of pneumonia. His urine examination showed the presence of haemoglobin and myoglobin. On repeated questioning it was found that he had a moth ball in his mouth a few days prior to this medical episode. This case illustrates a rarely described complication of myolysis in G6PD deficient persons on exposure to a strong oxidant. A review of the literature showed that most people with G6PD deficiency tolerate exercise well without untoward effect in muscles. However, assay of myoglobin in urine has not been routinely performed in these patients during acute haemolytic episode, and thus it is uncertain how frequent myoglobulinaemia occurs in a similar stress situation.

Squeezing for Life – Properties of Red Blood Cell Deformability

“…G6PD deficiency is the most common RBC enzyme deficiency with over 400 million affected people ( Cappellini and Fiorelli, 2008 ). Deficiency of this enzyme is associated with decreased ability of the RBC to withstand oxidative stress ( Cappellini and Fiorelli, 2008 ; Mangat et al, 2014 ; Tang et al, 2015 ). Exposure of normal and G6PD-deficient RBCs to the oxidant diamide leads to a decrease in RBC deformability of the G6PD-deficient RBCs due to the inability of the RBC to maintain the intracellular glutathione-pool ( Tang et al, 2015 ).…”

New Diagnosis of G6PD Deficiency Presenting as Severe Rhabdomyolysis

“…One was a 34-year-old Black male diagnosed with sickle cell trait and G6PD deficiency after presenting with rhabdomyolysis and acute hemolytic anemia 24 hours after vigorous exercise [ 8 ]. The other case was a two-year-old AA male with SCT diagnosed with a G6PD deficiency after he developed rhabdomyolysis and acute hemolysis on exposure to a mothball [ 9 ]. In these two cases, G6PD deficiency in concert with SCT likely precipitated rhabdomyolysis and hemolysis.…”

Febrile rhabdomyolysis of unknown origin in refugees coming from West Africa through the Mediterranean

“…Other haematological disorders and haemoglobinopathies have been recognized as associated with rhabdomyolysis, such as glucose-6-phosphate dehydrogenase (G6PDH) deficiency (Mangat et al, 2014) and thalassemia (Niwa et al, 1979), especially in situations of stress, after exposure to a strong oxidant, food items, or medicines, or drug intake.…”