Unexpected Intravascular Hemolysis and Methemoglobinemia during Treatment for Lymphoma

James O. Ballard^1, , Edward J. Wyluda¹, Hong Zheng¹ and Michael H. Creer¹

¹Penn State Hershey Medical Center, Hershey, PA, U.S.A.

Cite this paper:
James O. Ballard, Edward J. Wyluda, Hong Zheng and Michael H. Creer. Unexpected Intravascular Hemolysis and Methemoglobinemia during Treatment for Lymphoma. American Journal of Medical Case Reports. 2016; 4(4):144-147. doi: 10.12691/ajmcr-4-4-9

Abstract

A patient undergoing chemotherapy for relapsed non Hodgkin lymphoma developed tumor lysis syndrome, hypoxia and the abrupt onset of intravascular hemolysis. A past history of unexplained anemia and the finding of blister cells on peripheral smear led to the suspicion of congenital glucose phosphate dehydrogenase (G6PD) deficiency with intravascular hemolysis induced by the drug rasburicase. G6PD deficiency was confirmed by quantitative G6PD assay one month after the episode. Retrospective review of arterial blood gas data confirmed the transient presence of methemoglobinemia accompanying the hemolytic event. Health care providers should be aware of the potential for patients with previously undiagnosed G6PD deficiency to develop hemolysis and methemoglobinemia when oxidant drugs such as rasburicase are administered.

Keywords:
hemolytic anemia non-Hodgkin lymphoma rasburicase methemoglobinemia

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