Therapeutic whole blood exchange in the management of methaemoglobinemia: Case series and systematic review of literature

Singh, Pawan; Kodati, Rakesh; Agarwal, Ritesh; Tripathi, Paramatma P.; Dhooria, Sahajal; Sehgal, Inderpaul Singh; Prasad, Kuruswamy Thurai; Hans, Rekha; Sharma, Rattiram; Sharma, Navneet; Lad, Deepesh; Aggarwal, Ashutosh N.; Muthu, Valliappan

doi:10.1111/tme.12666

Cited by 17 publications

(10 citation statements)

References 39 publications

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“…If there is no improvement with the use of repeated dose of MB, therapeutic whole blood exchange (TWBE) or hyperbaric oxygen therapy should be considered 84–88 . In a systematic review, TWBE lead to a survival rate of 81.6% in patients refractory to MB 89,90 …”

Section: Introductionmentioning

confidence: 99%

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Recommendations for diagnosis and treatment of methemoglobinemia

et al. 2021

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Methemoglobinemia is a rare disorder associated with oxidization of divalent ferroiron of hemoglobin (Hb) to ferri-iron of methemoglobin (MetHb). Methemoglobinemia can result from either inherited or acquired processes. Acquired forms are the most common, mainly due to the exposure to substances that cause oxidation of the Hb both directly or indirectly. Inherited forms are due either to autosomal recessive

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Section: Introductionmentioning

confidence: 99%

“… 84 , 85 , 86 , 87 , 88 In a systematic review, TWBE lead to a survival rate of 81.6% in patients refractory to MB. 89 , 90 …”

Section: Introductionmentioning

confidence: 99%

Recommendations for diagnosis and treatment of methemoglobinemia

et al. 2021

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“…Those with higher concentrations of methaemoglobin and severe symptoms should be treated with intravenous methylene blue, ascorbic acid, or red cell exchange transfusion. 4 Methaemoglobinemia in SARS-CoV-2 infection has been described with severe infection, G6PD deficiency or treatment with hydroxychloroquine ( Table 1 ). 5 – 9 In our case, SARS-CoV-2 was probably a ‘red herring’.…”

Section: Discussionmentioning

confidence: 99%

SARS-CoV-2 infection, pulse oximetry, and interpretive caveats

et al. 2022

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Hypoxaemia in COVID-19 does not necessarily imply COVID pneumonia or post-COVID lung fibrosis, and the caveats of finger pulse oximetry should be remembered. Drug-induced methaemoglobinemia should be considered in individuals with unexplained cyanosis, refractory hypoxaemia, or the presence of a saturation gap. Here, we share our recent encounter of ‘spurious hypoxia’ in a patient with COVID-19 and methaemoglobinemia.

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“…Ascorbic acid (Vitamin C) taken intravenously can be used in a patient where methylene blue is contraindicated [ 18 ]. Exchange transfusion and hyperbaric oxygen have been used in severe refractory cases of methemoglobinemia [ 20 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

A Case of Severe Hypoxia Caused by Phenazopyridine-Induced Methemoglobinemia: A near Fatal Event from Over-the-Counter Medication Use

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Sharma

et al. 2022

Clinics and Practice

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Methemoglobinemia is a rare blood disorder characterized by the oxidation of heme iron from ferrous (Fe2+) to ferric (Fe3+) state, which increases oxygen affinity and impairs oxygen release to the tissue causing hypoxia. It can be congenital or acquired; however, most cases are acquired and caused by exogenous substances such as medications, chemicals, and environmental substances. Phenazopyridine is an over-the-counter urinary analgesic medication commonly used for symptomatic relief of dysuria and has been reported to cause methemoglobinemia. However, only a handful of cases of phenazopyridine-induced methemoglobinemia have been reported. We present a case of an 89-year-old female who presented with severe hypoxia, shortness of breath, headache, nausea, and dizziness caused by phenazopyridine-induced methemoglobinemia. She was found to have a methemoglobin level of 21.5% and was treated with methylene blue, leading to a rapid improvement of her symptoms. She was taking one over-the-counter phenazopyridine 200 mg tablet three times daily for two weeks for her chronic dysuria. This case highlights the need to have a high index of suspicion of phenazopyridine-induced methemoglobinemia in a patient presenting with unexplained shortness of breath with a history of phenazopyridine use as it could lead to severe methemoglobinemia with hypoxia that could potentially be fatal if not promptly diagnosed.

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Therapeutic whole blood exchange in the management of methaemoglobinemia: Case series and systematic review of literature

Cited by 17 publications

References 39 publications

Recommendations for diagnosis and treatment of methemoglobinemia

Recommendations for diagnosis and treatment of methemoglobinemia

SARS-CoV-2 infection, pulse oximetry, and interpretive caveats

A Case of Severe Hypoxia Caused by Phenazopyridine-Induced Methemoglobinemia: A near Fatal Event from Over-the-Counter Medication Use

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