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Case Reports
. 2021 Apr 10;13(4):e14406.
doi: 10.7759/cureus.14406.

Rasburicase-Induced Methemoglobinemia

Moeed Ahmed  1 , Thomas Sanchez  1 , Selinam Norgbe  1 , Christopher R Picking  1 , Paul G Millner  1
Affiliations
Case Reports

Rasburicase-Induced Methemoglobinemia

Moeed Ahmed et al. Cureus. .

Abstract

Methemoglobinemia occurs as iron in heme is oxidized to its ferric state, resulting in a decreased ability of hemoglobin to bind and release oxygen. Rasburicase is a recombinant urate-oxidase enzyme used in the prevention of tumor lysis syndrome. Methemoglobinemia can occur as a rare complication of treatment with rasburicase, primarily in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency. Methylene blue, an agent used for treating methemoglobinemia, should be avoided in patients with G6PD deficiency. In patients with G6PD deficiency, methylene blue is inadequately reduced to its active form, which then causes the methylene blue to further the oxidize the hemoglobin to methemoglobin that can result in hemolysis.

Keywords: methemoglobinemia; rasburicase.

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Conflict of interest statement

The authors have declared that no competing interests exist.

References

    1. Uric acid and cardiovascular risk. Feig DI, Kang DH, Johnson RJ. N Engl J Med. 2008;359:1811–1821. - PMC - PubMed
    1. Howard SC, Pui CH, Ribeiro RC. Renal Disease in Cancer Patients. Amsterdam, Netherlands: Elsevier Science; 2014. Tumor lysis syndrome; pp. 39–64.
    1. Rasburicase (Elitek): a novel agent for tumor lysis syndrome. Ueng S. https://www.tandfonline.com/doi/abs/10.1080/08998280.2005.11928082. Proc (Bayl Univ Med Cent) 2005;18:275–279. - PMC - PubMed
    1. Methemoglobinemia: etiology, pharmacology, and clinical management. Wright RO, Lewander WJ, Woolf AD. https://www.sciencedirect.com/science/article/abs/pii/S0196064499701678. Ann Emerg Med. 1999;34:646–656. - PubMed
    1. A perfect storm: tumor lysis syndrome with rasburicase-induced methemoglobinemia in a G6PD deficient adult. Montgomery KW, Booth GS. J Clin Apher. 2017;32:62–63. - PubMed

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