Primaquine-induced Severe Hemolysis in the Absence of Concomitant Malaria: Effects on G6PD Activity and Renal Function
Issued Date
2023-01-01
Resource Type
ISSN
00029637
eISSN
14761645
Scopus ID
2-s2.0-85146193337
Pubmed ID
36509054
Journal Title
American Journal of Tropical Medicine and Hygiene
Volume
108
Issue
1
Start Page
76
End Page
80
Rights Holder(s)
SCOPUS
Bibliographic Citation
American Journal of Tropical Medicine and Hygiene Vol.108 No.1 (2023) , 76-80
Suggested Citation
Douglas N.M., Piera K.A., Rumaseb A., Ley B., Anstey N.M., Price R.N. Primaquine-induced Severe Hemolysis in the Absence of Concomitant Malaria: Effects on G6PD Activity and Renal Function. American Journal of Tropical Medicine and Hygiene Vol.108 No.1 (2023) , 76-80. 80. doi:10.4269/ajtmh.21-0834 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/81981
Title
Primaquine-induced Severe Hemolysis in the Absence of Concomitant Malaria: Effects on G6PD Activity and Renal Function
Author(s)
Other Contributor(s)
Abstract
Primaquine prevents relapses of Plasmodium vivax malaria but can cause severe hemolysis in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency. The clinical and laboratory features of this outcome are usually confounded by the clinical and hemolytic effects of concomitant malaria. We describe a case of severe hemolysis occurring after a total dose of 2.04 mg/kg of primaquine used for prophylaxis in a young, G6PD-deficient (Kaiping variant), Australian man without malaria. During acute hemolysis, he had markedly elevated urinary beta-2-microglobulin, suggestive of renal tubular injury (a well-recognized complication of primaquine-induced hemolysis). He also had albuminuria and significantly increased excretion of glycocalyx metabolites, suggestive of glomerular glycocalyx degradation and injury. We show that regularly dosed paracetamol given for its putative renoprotective effect is safe in the context of severe oxidative hemolysis. Acute drug-induced hemolysis transiently increases G6PD activity. Cases such as this improve our understanding of primaquine-induced hemolysis and ultimately will help facilitate widespread safe and effective use of this critically important drug.