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Acalypha indica-induced transient glucose-6-phosphate dehydrogenase deficiency with acute haemolysis
  1. Sapol Thepwiwatjit1,
  2. Nattiya Teawtrakul1,
  3. Thanachit Krikeerati1 and
  4. Thapanawong Mitsungnern2
  1. 1Internal Medicine, Khon Kaen University Faculty of Medicine, Khon Kaen, Thailand
  2. 2Emergency Medicine, Khon Kaen University, Khon Kaen, Thailand
  1. Correspondence to Dr Sapol Thepwiwatjit; sapol.the{at}


Acalypha indica is a tropical herb found in Asia. The entire plant, especially the leaves, is used in herbal medicine for several therapeutic purposes. Acute intravascular haemolysis and methaemoglobinaemia have been reported in patients who consume this herb. We present a case of a previously healthy middle-aged man who ingested boiled leaves of A. indica. The patient developed clinical symptoms and signs of intravascular haemolysis 7 days after ingestion. Peripheral blood smear showed typical findings of glucose-6-phosphate dehydrogenase (G6PD) deficiency with acute haemolysis. The G6PD activity was low during active haemolysis. The G6PD level, however, returned to normal after 4 months of follow-up. The patient was further tested for common G6PD gene mutations in Southeast Asia and was negative. Ingestion of A. indica may induce transient G6PD deficiency, which in this patient led to acute haemolysis and methaemoglobinaemia.

  • haematology (drugs and medicines)
  • haematology (incl blood transfusion)
  • toxicology

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  • Contributors ST and NT participated in the management of the case and preparation and critical review of the manuscript. TK and TM participated in the management of the case and preparation of the manuscript.

  • 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.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

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