Rapid G6PD Screening Workflow for Timely Tumor Lysis Syndrome Management in Pediatric Oncology

Glucose-6-phosphate dehydrogenase deficiency (G6PDD) poses significant safety concerns in pediatric oncology, particularly during tumor lysis syndrome (TLS) management where rasburicase may precipitate hemolysis or methemoglobinemia. Prior to this initiative, our institution relied on send-out quantitative G6PD testing with prolonged turnaround times (TAT), limiting timely clinical decision-making.

A rapid, in-house qualitative G6PD screening assay with reflex quantitative testing for abnormal ("Intermediate" or "Deficient") results was implemented and incorporated into institutional TLS guidelines. Test utilization, TAT, and concordance between qualitative screening, quantitative enzyme activity, and World Health Organization (WHO) classification criteria were evaluated.

A total of 106 patients underwent qualitative G6PD screening between August 2025 and March 2026. Average TAT was less than 7 hours across all campuses. Screening classified 7 patients as "Deficient," 56 as "Intermediate," and 43 as "Normal." 66 patients underwent quantitative testing, of whom 23 had enzyme activity below the age-specific reference range. These included all 7 patients classified as "Deficient" and 16 initially classified as "Intermediate." However, only 1 patient met WHO criteria for clinically significant G6PD deficiency (<30% activity).

Rapid G6PD screening supported timely TLS management. Reflex quantitative testing remains essential, as interpretation varies substantially between qualitative screening, quantitative reference intervals, and WHO activity-based criteria.