Severe acute haemolytic anaemia associated with severe methaemoglobinaemia in a G6PD-deficient man

Rehman, Abdul; Shehadeh, Mohanad; Khirfan, Diala; Jones, Akhnuwhkh

doi:10.1136/bcr-2017-223369

Cited by 41 publications

(46 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Oxidative chemicals may cause both acute hemolysis and methemoglobinemia. [15][16][17] Although this plant contains cyanogenic glycosides and hydrogen cyanide, no patient developed or demonstrated any signs/symptoms of cyanide poisoning.…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics of Acalypha indica Poisoning

Pradoo

Sriapha

Trakulsrichai

et al. 2020

IJGM

View full text Add to dashboard Cite

Background: Acalypha indica is a tropical plant used as a herbal medicine in various parts of the world, including Thailand. In glucose-6-phosphate dehydrogenase (G6PD)-deficient patients, acute hemolysis has been reported following the ingestion of this plant. Methemoglobinemia was reported in the present study. Patients and Methods: Descriptive data of patients who suffered from Acalypha indica toxicity reported from different hospitals to the Ramathibodi Poison Center were retrieved from 2011 to 2019. Results: Eight patients were included, mostly male with a median age of 61.5 years. The plant was ground for fresh juice or boiled before consuming as herbal medicine. All patients presented with dark urine. Most had jaundice and fever, and all reported hemolysis. Seven out of eight patients were diagnosed as methemoglobinemia. Methemoglobin level was confirmed in five patients with the highest level of 23.9%. Early symptoms occurred within 24 hours of the last ingested dose. Discussion: In previous case reports of Acalypha indica ingestion, acute hemolysis was mostly observed in G6PD-deficient patients, consistent with the current findings. However, our patients also demonstrated methemoglobinemia, with some constituents in this plant (quinine, 2-methyl anthraquinone and tectoquinone) implicated as the cause in previous studies. Further studies are crucial to validate these findings. Conclusion: We report a case series in which acute hemolysis and methemoglobinemia after Acalypha indica ingestion were observed. This study presents methemoglobinemia as the other toxicity caused by this plant.

show abstract

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics of Acalypha indica Poisoning

Pradoo

Sriapha

Trakulsrichai

et al. 2020

IJGM

View full text Add to dashboard Cite

show abstract

“…Accordingly, the clinical manifestations of G6PD may range from none to (i) erythroblastosis fetalis, chronic hemolysis, and (iii) acute hemolytic crisis [4]. Acute hemolytic crises, in particular, are usually caused by exposure to certain medications, systemic infections, and the consumption of fava beans [5, 6]. Here we report on the case of a patient in whom the first manifestations of G6PD deficiency occurred at age 86.…”

Section: Introductionmentioning

confidence: 99%

Late-Life Presentation of Unsuspected G6PD Deficiency

Benchimol

Madeira

Oliveira‐Souza

2018

Case Reports in Critical Care

View full text Add to dashboard Cite

Deficiency of glucose-6-phosphate dehydrogenase (G6PD) is the commonest enzyme deficiency in humans with a wide range of possible clinical manifestations depending on the specific genetic variant in each case. Here we present the case of an 86-year-old male of African descent who acutely developed symptoms of G6PD deficiency immediately after he received methylene blue for treating methemoglobinemia. The contrast between a low SO2 on pulse oximetry and a normal arterial gas sampling raised the possibility of methemoglobinemia. The patient was treated with packed red blood cells and folic acid, and a rapid clinical improvement followed by normalization of the red blood cell count ensued. In view of the patient's advanced age, the lack of a history of similar episodes in the past, and the normal laboratory results during the hemolytic crisis, this case remained a diagnostic challenge for over three months, when a follow-up measure of G6DP activity eventually confirmed the diagnosis. A latent deficiency of G6PD may become clinically manifest under the appropriate triggering conditions even in elderly patients and in the absence of past or current clinical and laboratory evidence of G6PD deficiency.

show abstract

“…Applying a dosing regimen of 1.5 g IV q6h, vitamin C serum concentrations are typically situated between 200 and 600 μmol/L [6]. Acute hemolytic anemia in a patient with severe methemoglobinemia and G6PD deficiency successfully resolved within 24 h following strictly monitored administration of 1 g vitamin C q6h [4]. However, a recent review reported that vitamin C doses of 4 to 6 g may propagate hemolysis [7].…”

mentioning

confidence: 99%

“…This illustrates that vitamin C administration in G6PD patients requires caution. Alternative treatment [4] should be preferred if methemoglobinemia develops. In the absence of a valid alternative, a maximal IV dose of 4 to 6 g vitamin C could be considered, provided that strict monitoring is guaranteed.…”

mentioning

confidence: 99%

“…Still, scarce data from the literature suggest that a vitamin C dose up to 6 g/day can be safely administered to patients with G6PD. Methemoglobinemia—the presence of methemoglobin in the blood—is most commonly treated with methylene blue [ 4 ]. However, methylene blue cannot be used in G6PD deficiency because it is ineffective and may even worsen G6PD deficiency-related hemolysis [ 4 ].…”

mentioning

confidence: 99%

See 1 more Smart Citation