Methaemoglobin is a form of haemoglobin in which the ferrous (Fe2+) ion contained in the iron–porphyrin complex of haem is oxidised to its ferric (Fe3+) state. Methaemoglobinaemia, the presence of methaemoglobin in the blood, is most commonly treated with methylene blue. However, methylene blue cannot be used in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency as it is ineffective in such patients and it can worsen G6PD deficiency haemolysis. We report the case of a 30-year-old man who presented with clinical features of G6PD deficiency-associated haemolysis and was found to have severe methaemoglobinaemia (35%). He was administered blood transfusions and intravenous ascorbic acid. His methaemoglobinaemia resolved within 24 hours. This case demonstrates the successful management of a patient with severe methaemoglobinaemia in the setting of G6PD deficiency haemolysis. Emergency physicians should be aware of the possible co-occurrence of severe methaemoglobinaemia in a patient with G6PD deficiency haemolysis.
- haematology (drugs and medicines)
- emergency medicine
- general practice / family medicine
- haematology (incl blood transfusion)
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Contributors All authors were involved in the direct care of the patient and conceived the idea of writing a case report. They collected the data and interpreted it. AR performed a literature review and wrote down the discussion section of the manuscript. MS and DK wrote down the case presentation section of the manuscript. AJ substantially reviewed the whole manuscript for important intellectual content. All authors read the manuscript and approved it for submission in its current form.
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 Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
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