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

Abdul Rehman1,2, Mohanad Shehadeh2, Diala Khirfan2

  • 1Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan.

BMJ Case Reports
|March 30, 2018
PubMed

Methaemoglobin is a form of haemoglobin in which the ferrous (Fe2+) ion contained in the iron-porphyrin complex of haem is oxidised to its ferric (Fe3+) state. Methaemoglobinaemia, the presence of methaemoglobin in the blood, is most commonly treated with methylene blue. However, methylene blue cannot be used in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency as it is ineffective in such patients and it can worsen G6PD deficiency haemolysis. We report the case of a 30-year-old man who presented with clinical features of G6PD deficiency-associated haemolysis and was found to have severe methaemoglobinaemia (35%). He was administered blood transfusions and intravenous ascorbic acid. His methaemoglobinaemia resolved within 24 hours. This case demonstrates the successful management of a patient with severe methaemoglobinaemia in the setting of G6PD deficiency haemolysis. Emergency physicians should be aware of the possible co-occurrence of severe methaemoglobinaemia in a patient with G6PD deficiency haemolysis.

Keywords:
emergency medicinegeneral practice / family medicinehaematology (drugs and medicines)haematology (incl blood transfusion)

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