Medicine · 2025
Co-occurrence of acute hemolytic anemia and methemoglobinemia in a 74-year-old female with G6PD deficiency: A case report.
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Chen Binze, Han Yanxia
Аннотация
RATIONALE: Acute hemolysis and methemoglobinemia rarely coexist in patients with glucose-6-phosphate dehydrogenase (G6PD)-deficient disease. Methylene blue is widely recognized as the first-line treatment for methemoglobinemia; however, it can worsen hemolysis owing to its oxidative effects in patients with G6PD deficiency.
PATIENT CONCERNS: A rare case of acute hemolytic anemia and methemoglobinemia induced by ingestion of fresh raw fava beans in a 74-year-old female with G6PD deficiency was reported in this paper.
DIAGNOSES: Laboratory test results revealed anemia (low hemoglobin level of 81 g/L) with evidence of hemolysis (high reticulocyte count 11.93%, high indirect bilirubin 155.7 μmol/L, high proportion of poikilocytes [16.5%] observed in peripheral blood smears). Arterial blood gas analysis showed a high methemoglobin level (7.3%). Detection of mutations in G6PD confirmed the diagnosis of G6PD deficiency.
INTERVENTIONS: The administration of methylene blue exacerbated the hemolysis of this patient, resulting in a sustained decrease in hemoglobin levels from 81 to 38 g/L. Methylene blue treatment was replaced by vitamin C and methylprednisolone upon diagnosis of G6PD deficiency.
OUTCOMES: The clinical symptoms of this patient were gradually improved after vitamin C and methylprednisolone treatment, and 1 month after discharge, the hemoglobin level recovered to within the normal range.
LESSONS: Our case highlights the importance of evaluating G6PD deficiency as soon as the patient is first diagnosed with methemoglobinemia. Although acute hemolytic anemia and methemoglobinemia rarely co-occur in elderly patients with G6PD deficiency, care should be taken with methylene blue, which can worsen hemolysis. The fava bean plays an important role in the hemolytic crisis. Therefore, it is crucial to identify the cause of oxidative stress and its co-occurrence to prevent further oxidative stress-induced hemolysis.
PATIENT CONCERNS: A rare case of acute hemolytic anemia and methemoglobinemia induced by ingestion of fresh raw fava beans in a 74-year-old female with G6PD deficiency was reported in this paper.
DIAGNOSES: Laboratory test results revealed anemia (low hemoglobin level of 81 g/L) with evidence of hemolysis (high reticulocyte count 11.93%, high indirect bilirubin 155.7 μmol/L, high proportion of poikilocytes [16.5%] observed in peripheral blood smears). Arterial blood gas analysis showed a high methemoglobin level (7.3%). Detection of mutations in G6PD confirmed the diagnosis of G6PD deficiency.
INTERVENTIONS: The administration of methylene blue exacerbated the hemolysis of this patient, resulting in a sustained decrease in hemoglobin levels from 81 to 38 g/L. Methylene blue treatment was replaced by vitamin C and methylprednisolone upon diagnosis of G6PD deficiency.
OUTCOMES: The clinical symptoms of this patient were gradually improved after vitamin C and methylprednisolone treatment, and 1 month after discharge, the hemoglobin level recovered to within the normal range.
LESSONS: Our case highlights the importance of evaluating G6PD deficiency as soon as the patient is first diagnosed with methemoglobinemia. Although acute hemolytic anemia and methemoglobinemia rarely co-occur in elderly patients with G6PD deficiency, care should be taken with methylene blue, which can worsen hemolysis. The fava bean plays an important role in the hemolytic crisis. Therefore, it is crucial to identify the cause of oxidative stress and its co-occurrence to prevent further oxidative stress-induced hemolysis.