Most common inherited enzyme deficiency affecting red blood cells. G6PD
is a critical antioxidant—a deficiency can predispose to oxidation and
subsequent hemolysis of the red blood cell.
Common oxidants include:
sulfonamides, furantoins, chloramphenicol, large doses of ascorbic acid,
dapsone(>200mg/day), chloroquine, methylene blue, nalidixic acid,
penicillamine, primaquine, quinadine & quinine.
The degree of hemolysis induced by a drug may be accentuated by the
presence of additional factors (infection or disease state etc).The
severity of the reaction is dependent on the type of G6PD deficiency
(Mediterranean deficiency-Caucasian (most severe) ; Blacks (usually mild
to moderate). The sex of the patient is also important—males are at
greater risk based on severity compared to females.
Conclusion: G6PD is not an absolute contraindication to
the use of oxidizing agents. Decisions should be based on a risk vs
benefit analysis (consider severity of disease; sex of patient;
availability of other agents; type of deficiency). If therapy is
initiated, the patient should be monitored closely for adverse effects.
Patients with G6PD deficiency will exhibit signs within 1-3 days of
initiation of treatment. Symptoms may include abdominal or back pain in
severe cases. The urine of the patient will darken in color.
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