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Rasburicase-induced haemolysis and methemoglobinemia: an ongoing issue
  1. Luai Madanat1,
  2. Daniel Schoenherr2,
  3. Elizabeth Wey3 and
  4. Ruby Gupta4
  1. 1Department of Internal Medicine, William Beaumont Hospital, Royal Oak, Michigan, USA
  2. 2Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
  3. 3Department of Pathology, William Beaumont Hospital, Royal Oak, Michigan, USA
  4. 4Department of Hematology and Oncology, William Beaumont Hospital, Royal Oak, Michigan, USA
  1. Correspondence to Dr Ruby Gupta; RUBY.GUPTA{at}BEAUMONT.ORG


We report a case of a 91-year-old Caucasian woman with a history of chronic lymphocytic leukaemia who developed acute hypoxic respiratory failure (AHRF) requiring intubation for less than 24 hours after receiving rasburicase. Laboratory workup was significant for methemoglobinemia and acute anaemia, and blood film demonstrated evidence of oxidative haemolysis with bite cells. The patient was given a presumptive diagnosis of glucose-6-phosphate dehydrogenase (G6PD) deficiency and was managed conservatively with successful resolution of AHRF and stabilisation of haemoglobin level. Seven days after admission, she passed away due to subsequent complications; hence, follow-up G6PD level could not be obtained. Haemolytic anaemia and methemoglobinemia in the setting of recent rasburicase administration should raise clinical suspicion for G6PD deficiency. In non-emergent cases, patients should be screened prior to receiving rasburicase regardless of risk factors. Because rasburicase is often needed emergently, patients at high risk of tumour lysis syndrome should be screened early for G6PD deficiency.

  • haematology (drugs and medicines)
  • medical management
  • unwanted effects / adverse reactions

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  • Contributors LM: manuscript idea, research and writing. DS: writing and editing. EW: research, review and editing. RG: revision and editing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Next of kin consent obtained.

  • Provenance and peer review Not commissioned; externally peer-reviewed.