Co-Occurring Hemolysis and Methemoglobinemia After COVID-19 Infection in Patient With G6PD Deficiency

Abstract

Hemolytic anemia and methemoglobinemia are known complications in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency. They can be elicited by various oxidative stressors.Here we report a case of an adult with the first episode of G6PD deficiency associated hemolysis and methemoglobinemia after acquiring COVID-19 infection, who had no recent exposure to oxidative drugs or fava beans. A 52-year-old gentleman known to have myocardial bridging on aspirin and beta-blocker, with no other medical illnesses, developed anemia symptoms, jaundice, and hypoxia after contracting COVID-19 infection. Further laboratory work revealed non-immune hemolytic anemia, methemoglobinemia, and a positive G6PD screen test. He was treated conservatively with a blood transfusion, and his oxygen saturation improved thereafter.With the widespread COVID-19 infection and its morbidity worldwide, it is crucial to consider methemoglobinemia in the differential diagnosis of hypoxia. Testing for G6PD is an essential next step in such cases, as starting methylene blue in G6PD deficiency can worsen hemolysis. Apart from COVID-19, there is no other identified trigger for the acute event in this patient. It is not known whether COVID-19 infection alone is enough to result in G6PD deficiency-associated hemolysis and methemoglobinemia simultaneously.

Vitamin K and Glucose-6-phosphate Dehydrogenase Deficiency: A Perspective

“…49 There have been four anecdotal case reports of the first episode of G6PD deficiency-associated hemolysis and methemoglobinemia after acquiring COVID-19 infection, with no recent exposure to oxidative drugs, vitamin K or fava beans. 50,51 There have been reports of G6PD deficiency-related hemolysis being triggered by bacterial infections (mainly pneumonia) and viral upper respiratory tract infections without administration of vitamin K. 52 Thus, all cases of anemia in a child with viral hepatitis and other infections should always be carefully evaluated for the suspected underlying hemolytic state.…”