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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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G6PD deficiency