Hemolysis and Methemoglobinemia Secondary to Rasburicase Administration

2005 ◽  
Vol 39 (11) ◽  
pp. 1932-1935 ◽  
Author(s):  
Linda A Browning ◽  
James A Kruse
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Hemolytic Anemia ◽  
G6pd Deficiency ◽  
Tumor Lysis Syndrome ◽  
Simultaneous Occurrence ◽  
Arterial Blood Gas ◽  
Chemotherapy Administration ◽  
Arterial Blood ◽  
Patients At Risk

OBJECTIVE To report a case of hemolytic anemia and methemoglobinemia developing after rasburicase administration to a patient with glucose-6-phosphate dehydrogenase (G6PD) deficiency. CASE SUMMARY A 50-year-old African American man was hospitalized with new onset seizure, diabetic ketoacidosis, respiratory failure, and acute renal failure. Serum uric acid concentrations were elevated, and the patient was treated with one dose of intravenous rasburicase 22.5 mg for acute renal failure secondary to hyperuricemia. Routine arterial blood gas analyses performed after rasburicase was administered revealed elevated methemoglobin concentrations, which peaked at 14.7%. Hemolytic anemia developed as evidenced by a fall in blood hemoglobin from 14.8 to 5.3 g/dL. The patient made a full recovery following aggressive fluid therapy, blood transfusions, and respiratory support. G6PD deficiency was subsequently confirmed. The Naranjo probability scale indicated that rasburicase was a probable cause of hemolytic anemia and methemoglobinemia. DISCUSSION Rasburicase is contraindicated in patients with G6PD deficiency as it may cause hemolytic anemia and methemoglobinemia. As of September 26, 2005, simultaneous occurrence of hemolytic anemia and methemoglobinemia has not been reported in patients receiving rasburicase. CONCLUSIONS As of September 26, 2005, screening for G6PD deficiency should be performed whenever possible prior to chemotherapy administration in patients at risk of developing tumor lysis syndrome.

scholarly journals Amyl Nitrite Induced Hemolytic Anemia: Acute Therapy and Prevention

2020 ◽  
Author(s):  
Amira Elshikh ◽  
Ghazal Kango ◽  
Marwa Baalbaki ◽  
Jeffrey Lankowsky ◽  
Amandeep Bawa
Keyword(s):  
Methylene Blue ◽  
Hemolytic Anemia ◽  
G6pd Deficiency ◽  
Positive Outcome ◽  
Acute Therapy ◽  
Atypical Chest Pain ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Patient Reported ◽  
Recreational Use

Abstract Background: Inhaled nitrites have been a substance of recreational use for centuries, primarily among men who have sex with men (MSM). However, there is a lack of awareness of the use of inhaled nitrites in this population and the possible complications and health disparities it carries. This case report highlights the use of inhaled nitrites in an MSM male with an emphasis on the complications induced by this product, including severe hemolytic anemia and methemoglobinemia. Followed by a review of both acute therapy and preventative therapy by increasing provider awareness. Case presentation: A 62-year-old man with a past medical history of glucose-6 phosphate dehydrogenase (G6PD) deficiency presented to the emergency department with atypical chest pain. He was tachypneic and hypotensive with laboratory evidence of end organ damage. He had an acute drop in hemoglobin with elevated bilirubin concerning for acute hemolytic anemia. His arterial blood gas was significant for elevated methemoglobin. The patient reported recent use of “poppers” (inhaled nitrite) which is associated with formation of methemoglobin and hemolytic anemia. Given the severity of his symptoms and elevated methemoglobin, he met criteria for methylene blue administration. However, his G6PD deficiency is a contraindication to methylene blue and the patient was treated conservatively with a positive outcome. Conclusion: The following report presents a unique scenario in which a G6PD deficient patient presented with hemolytic anemia and methemoglobinemia after recreational use of inhaled nitrites. The case was complicated with the management challenge of methemoglobinemia in a patient with G6PD deficiency. Prior literature has shown that the use of nitrites is a predictor for high-risk sexual behavior and is associated with positive human immunodeficiency virus (HIV) status. Increasing provider awareness for appropriate counseling is of importance.

Continuous Hemodiafiltration in Children

PEDIATRICS ◽  
1990 ◽  
Vol 85 (5) ◽  
pp. 819-823
Author(s):  
Nancy A. Bishof ◽  
Thomas R. Welch ◽  
C. Frederic Strife ◽  
Frederick C. Ryckman
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Peritoneal Dialysis ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Effective Means ◽  
Tumor Lysis Syndrome ◽  
Intermittent Hemodialysis ◽  
Tumor Lysis ◽  
Continuous Arteriovenous Hemofiltration

Continuous arteriovenous hemofiltration is a form of renal replacement therapy whereby small molecular weight solutes and water are removed from the blood via convection, alleviating fluid overload and, to a degree, azotemia. It has been used in many adults and several children. However, in patients with multisystem organ dysfunction and acute renal failure, continuous arteriovenous hemofiltration alone may not be sufficient for control of azotemia; intermittent hemodialysis or peritoneal dialysis may be undesirable in such unstable patients. Recently, the technique of continuous arteriovenous hemodiafiltration has been used in many severely ill adults. We have used continuous arteriovenous hemodiafiltration in four patients at Children's Hospital Medical Center. Patient 1 suffered perinatal asphyxia and oliguria while on extracorporeal membrane oxygenation. Patients 2 and 4 both had Burkitt lymphoma and tumor lysis syndrome. Patient 3 had septic shock several months after a bone marrow transplant. All had acute renal failure and contraindications to hemodialysis or peritoneal dialysis. A blood pump was used in three of the four patients, while spontaneous arterial flow was adequate in one. Continuous arteriovenous hemodiafiltration was performed for varying lengths of time, from 11 hours to 7 days. No patient had worsening of cardiovascular status or required increased pressor support during continuous arteriovenous hemodiafiltration. The two survivors (patients 2 and 4) eventually recovered normal renal function. Continuous arteriovenous hemodiafiltration is a safe and effective means of renal replacement therapy in the critically ill child. It may be ideal for control of the metabolic and electrolyte abnormalities of the tumor lysis syndrome.

scholarly journals Acute Renal Failure Due to ( + )-Cyanidanol-3-Induced Hemolytic Anemia

Nephron ◽  
1987 ◽  
Vol 46 (3) ◽  
pp. 323-323 ◽  
Author(s):  
Enrico Imbasciati ◽  
Vincenzo De Cristofaro ◽  
Alberto Scherini ◽  
Giuliano Pradella ◽  
Salvatore Battaglia ◽  
...  
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Hemolytic Anemia

scholarly journals Probable Linezolid-Induced Pancytopenia

2005 ◽  
Vol 16 (5) ◽  
pp. 286-288 ◽  
Author(s):  
Nita Lakhani ◽  
William Thompson ◽  
Anne Marie Bombassaro
Keyword(s):  
Staphylococcus Aureus ◽  
Renal Failure ◽  
Acute Renal Failure ◽  
Cardiac Disease ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Deficiency Anemia ◽  
Patients At Risk ◽  
Baseline Values ◽  
Baseline Levels ◽  
Diabetic Foot Osteomyelitis

A 75-year-old male outpatient with cardiac disease, diabetes, chronic renal insufficiency and iron deficiency anemia was prescribed linezolid 600 mg twice daily for a methicillin-resistant Staphylococcus aureus diabetic foot osteomyelitis. After one week, his blood counts were consistent with baseline values. The patient failed to return for subsequent blood work. On day 26, he was admitted to hospital with acute renal failure secondary to dehydration, and was found to be pancytopenic (erythrocytes 2.5x1012/L, leukocytes 2.9x109/L, platelets 59x109/L, hemoglobin 71 g/L). The patient was transfused, and linezolid was discontinued. His blood counts improved over the week and remained at baseline two months later. The patient's decline in blood counts from baseline levels met previously established criteria for clinical significance. Application of the Naranjo scale indicated a probable relationship between pancytopenia and linezolid. Clinicians should be aware of this rare effect with linezolid, and prospectively identify patients at risk and emphasize weekly hematological monitoring.

Antazoline-induced Immune Hemolytic Anemia, Hemoglobinuria, and Acute Renal Failure

2009 ◽  
Vol 198 (1-6) ◽  
pp. 223-227 ◽  
Author(s):  
Ulla Bengtsson ◽  
Staffan Ahlstedt ◽  
Mattias Aurell ◽  
Bertil Kaijser
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Hemolytic Anemia ◽  
Immune Hemolytic Anemia

Hemolytic anemia and acute renal failure associated with temafloxacin-dependent antibodies

1994 ◽  
Vol 46 (4) ◽  
pp. 363-366 ◽  
Author(s):  
Robert B. Maguire ◽  
David F. Stroncek ◽  
Eric Gale ◽  
Martha Yearlsey
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Hemolytic Anemia
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