Rasburicase-Induced Hemolytic Anemia Secondary to Undiagnosed G6PD Deficiency

A 55 year old African American male with a medical history of diffuse large B-cell lymphoma (DLBCL) receiving chemotherapy presents for fatigue and dark red urine. Five days prior to this presentation, the patient was seen at his oncology clinic for progression of his cancer. The patient was started on a new chemotherapy regimen as well as rasburicase and allopurinol for hyperuricemia thought to be secondary to tumor lysis syndrome. Subsequent lab work indicated acute hemolytic anemia. Etiology was suspected to be hemolytic anemia triggered by rasburicase in the setting of undiagnosed G6PD deficiency. The patient recovered with supportive care including blood transfusions and cessation of rasburicase. G6PD deficiency is the most prevalent inherited erythrocyte disorder classically considered to impact populations in tropical Africa and Asia, however is estimated to impact approximately 10% of African American men. ¹⋅² This case exemplifies the importance of considering G6PD deficiency when administering medications that cause increased oxidative stress, such as rasburicase, in addition to the swift recognition and management of subsequent complications.