Hemolytic crisis in G6PD-deficient individuals in the occupational setting

Glucose-6-phosphate dehydrogenase (G6PD) deficiency affects an estimated 400 million people. Most of the individuals affected live in Africa, the Middle East and Southeast Asia, or are African-Americans. The ethnic distribution of G6PD-deficiency is extremely variable in Israel--where the Jewish population has been repatriated from more than 60 different countries--its prevalence being from 0% to 58%. Five cases of hemolytic episodes arising from the loading of trinitrotoluene (TNT) were detected. Hemoglobin levels dropped between 4 and 10.2 g/dl. Reticulocytosis reached 4%-26.2% of red blood cells, while bilirubin levels rose to a peak of 5.1 mg/dl. Methemoglobin was 1.5%-8.6% and sulfmethemoglobin 0.9%-4.93% of total hemoglobin. Urinary urobilinogen was increased in all. All five workers showed absolute G6PD deficiency. In one worker a urinary metabolite of TNT 2-6 dinitromono amino toluene, was detected.