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Case Reports
. 2018 Mar 28:2018:bcr2017223369.
doi: 10.1136/bcr-2017-223369.

Severe acute haemolytic anaemia associated with severe methaemoglobinaemia in a G6PD-deficient man

Abdul Rehman  1   2 , Mohanad Shehadeh  2 , Diala Khirfan  2 , Akhnuwhkh Jones  2
Affiliations
Case Reports

Severe acute haemolytic anaemia associated with severe methaemoglobinaemia in a G6PD-deficient man

Abdul Rehman et al. BMJ Case Rep. .

Abstract

Methaemoglobin is a form of haemoglobin in which the ferrous (Fe2+) ion contained in the iron-porphyrin complex of haem is oxidised to its ferric (Fe3+) state. Methaemoglobinaemia, the presence of methaemoglobin in the blood, is most commonly treated with methylene blue. However, methylene blue cannot be used in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency as it is ineffective in such patients and it can worsen G6PD deficiency haemolysis. We report the case of a 30-year-old man who presented with clinical features of G6PD deficiency-associated haemolysis and was found to have severe methaemoglobinaemia (35%). He was administered blood transfusions and intravenous ascorbic acid. His methaemoglobinaemia resolved within 24 hours. This case demonstrates the successful management of a patient with severe methaemoglobinaemia in the setting of G6PD deficiency haemolysis. Emergency physicians should be aware of the possible co-occurrence of severe methaemoglobinaemia in a patient with G6PD deficiency haemolysis.

Keywords: emergency medicine; general practice / family medicine; haematology (drugs and medicines); haematology (incl blood transfusion).

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
A figure depicting the timeline and sequence of events that occurred in the present case. ED, emergency department.
See this image and copyright information in PMC

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