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Disorders of Hemostasis

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Hemostasis, the process that stops bleeding after a blood vessel injury, is crucial for maintaining the integrity of the circulatory system. However, disorders of hemostasis can disrupt this delicate balance, leading to either excessive clotting or bleeding. These disorders can be broadly classified into thromboembolic disorders and bleeding disorders.
Thromboembolic Disorders
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Hemolysis attributed to high dose vitamin C: Two case reports.

Shi-Wan Wang¹, Xiao-Wei Zhang¹, Jin-Xiu Qu¹

¹Center for Oncology Nutrition and Metabolism, Beijing Shijitan Hospital, Capital Medical University/Key Laboratory of Cancer FSMP for State Market Regulation, Beijing 100038, China.

World Journal of Clinical Cases

|June 20, 2024

Summary

High-dose vitamin C treatment (HVCT) can cause severe hemolysis, especially in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency. This review highlights the risks and suggests contraindications for HVCT to prevent adverse events.

Keywords:

Acute kidney injury Adverse effects Cancer Case report Hemolysis Vitamin C

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Area of Science:

Oncology
Pharmacology
Hematology

Background:

High-dose vitamin C treatment (HVCT) is explored as an adjunct cancer therapy, often considered safe.
However, severe adverse effects, including potentially fatal hemolysis, are increasingly recognized.
The exact mechanisms and risk factors for HVCT-induced hemolysis, particularly in glucose-6-phosphate dehydrogenase (G6PD) deficiency, require further elucidation.

Observation:

Two colorectal cancer patients developed severe hemolytic anemia following HVCT (1 g/kg).
Hemoglobin levels dropped below 50 g/L, exceeding previously reported severities.
Co-existing conditions like chronic hepatitis B and bone marrow suppression may exacerbate hemolysis.

Findings:

All reviewed patients with G6PD deficiency experienced hemolysis after HVCT.
The presented cases, despite extreme hemolysis, showed a favorable prognosis with blood replacement therapy.
This suggests potential therapeutic strategies for managing drug-induced hemolysis.

Implications:

G6PD deficiency must be considered a strict contraindication for HVCT.
Patients with pre-existing anemia, bone marrow suppression, or abnormal liver/kidney function should avoid HVCT.
Prompt blood purification and steroid therapy are crucial for mitigating severe outcomes like acute kidney injury or death.