Related Experiment Video
Updated: Sep 7, 2025
A Rapid and Specific Microplate Assay for the Determination of Intra- and Extracellular Ascorbate in Cultured Cells
Published on: April 11, 2014
Vitamin C-induced Hemolysis: Meta-summary and Review of Literature
Deven Juneja1, Ravi Jain2, Prashant Nasa3
1Institute of Critical Care Medicine, Max Super Speciality Hospital, New Delhi, India.
Insights
High-dose vitamin C can cause serious complications like hemolysis, especially in individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency. Physicians should exercise caution when prescribing vitamin C, particularly high doses or intravenous forms.
Area of Science:
- Medicine
- Biochemistry
- Pharmacology
Background:
- Vitamin C (ascorbic acid) is widely used, with high doses often considered safe.
- However, reports of adverse events, including hemolysis, necessitate a closer examination.
Purpose of the Study:
- To systematically review and summarize case reports of vitamin C-induced hemolysis.
- To identify risk factors, clinical presentations, and outcomes associated with vitamin C-related hemolysis.
Main Methods:
- A systematic literature search was conducted across PubMed, Science Direct, and Google Scholar databases from January 1975 to July 31, 2021.
- Search terms included "Vitamin C" OR "ascorbic acid" AND "haemolysis" OR "haemolytic anaemia."
- Data extraction focused on patient demographics, vitamin C dosage, duration, formulation, and clinical outcomes.
Main Results:
- Fourteen case reports met the inclusion criteria, involving patients aged 3 weeks to 75 years, with males predominating (78.6%).
- A significant proportion (71.4%) had glucose-6-phosphate dehydrogenase (G6PD) deficiency.
- High doses (1-200 g/day), particularly intravenous formulations (57.1%), were common. Half of the patients experienced complications like acute kidney injury (AKI) and methemoglobinemia, with most adverse events occurring within 3 days.
Conclusions:
- While generally safe, vitamin C, especially at high doses or in G6PD-deficient individuals, carries risks of severe hemolysis and other complications like AKI.
- Physicians must carefully weigh the benefits against risks and monitor patients for adverse effects.
Abstract:
Vitamin C is increasingly being used, and even high doses are considered safe. However, complications including hemolysis have been reported. We performed a systematic search from PubMed, Science Direct, and Google Scholar databases from January 1975 till July 31, 2021. Search terms used were "Vitamin C" OR "ascorbic acid" AND "haemolysis" OR "haemolytic anaemia." Data regarding patient's demographics, outcomes and dose, duration, and form of vitamin C were extracted. Fourteen case reports matched the selected criteria, with age ranging from 3 weeks to 75 years with 78.6% being males. About 71.4% were diagnosed to have glucose-6-phosphate dehydrogenase (G6PD) deficiency but previous hemolysis was reported in only two patients, and 57.1% were prescribed vitamin C for nutritional supplementation. The dose ranged from 1 to 200 g/day with 57.1% receiving intravenous formulations. Half of these patients developed other complications including acute kidney injury (AKI), disseminated intravascular coagulation, oxalosis, and methemoglobinemia. About 78.6% developed complications within 3 days of starting vitamin C and only one death was reported. Vitamin C is generally a safe drug but it should be prescribed with caution and only when benefits outweigh the risks. Physicians should be aware of potential complications like severe hemolysis and AKI, especially when using high doses and in G6PD deficiency.
How To Cite This Article:
Juneja D, Jain R, Nasa P. Vitamin C-induced Hemolysis: Meta-summary and Review of Literature. Indian J Crit Care Med 2022;26(2):224-227.
Related Concept Videos
01:01Regulation of Hematopoietic Stem Cells
01:30Vitamins
01:18Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...