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Rasburicase-induced Hemolytic Anemia in an Adolescent With Unknown Glucose-6-Phosphate Dehydrogenase Deficiency

Manzilat Akande1, Anthony N Audino1, Joseph D Tobias1

  • 1Division of Pediatric Critical Care Medicine (MA), Nationwide Children's Hospital, Columbus, Ohio, Department of Pediatrics (MA, ANA), The Ohio State University College of Medicine, Columbus, Ohio, Division of Pediatric Hematology/Oncology/BMT (ANA), Nationwide Children's Hospital, Columbus Ohio, Department of Anesthesiology & Pain Medicine (JTD), Nationwide Children's Hospital, Columbus, Ohio, and Department of Anesthesiology & Pain Medicine (JTD), The Ohio State University College of Medicine, Columbus, Ohio.

The Journal of Pediatric Pharmacology and Therapeutics : JPPT : the Official Journal of PPAG
|January 2, 2018
PubMed

Rasburicase, used in the prevention and treatment of tumor lysis syndrome (TLS), may cause hemolytic anemia and methemoglobinemia in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency. Although routine screening for G6PD deficiency has been recommended, given the turnaround time for test results and the urgency to treat TLS, such screening may not be feasible. We report a case of rasburicase-induced hemolytic anemia without methemoglobinemia in an adolescent with T-cell lymphoblastic lymphoma, TLS, and previously unrecognized G6PD deficiency. Previous reports of hemolytic anemia with rasburicase are reviewed, mechanisms discussed, and preventative strategies presented.

Keywords:
case reportglucose-6-phosphate dehydrogenase deficiencyhemolytic anemiapediatric intensive carerasburicase

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