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Published Online, 4 October 2005, www.theannals.com, DOI 10.1345/aph.1G272.
 The Annals of Pharmacotherapy: Vol. 39, No. 11, pp. 1932-1935. DOI 10.1345/aph.1G272
© 2005 Harvey Whitney Books Company.
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Hemolysis and Methemoglobinemia Secondary to Rasburicase Administration

Linda A Browning, PharmD

Clinical Pharmacy Specialist, Department of Pharmacy Services, Detroit Receiving Hospital, Detroit Medical Center, Detroit, MI

James A Kruse, MD

Chief, Division of Critical Care Medicine, Mary Imogene Bassett Hospital, Cooperstown, NY

Reprints: Dr. Browning, Department of Pharmacy Services, Detroit Receiving Hospital, 4201 St. Antoine Blvd., Detroit, MI 48201-2403, fax 313/745-1117, lbrownin{at}dmc.org

OBJECTIVE: To report a case of hemolytic anemia and methemoglobinemia developing after rasburicase administration to a patient with glucose-6-phosphate dehydrogenase (G6PD) deficiency.

CASE SUMMARY: A 50-year-old African American man was hospitalized with new onset seizure, diabetic ketoacidosis, respiratory failure, and acute renal failure. Serum uric acid concentrations were elevated, and the patient was treated with one dose of intravenous rasburicase 22.5 mg for acute renal failure secondary to hyperuricemia. Routine arterial blood gas analyses performed after rasburicase was administered revealed elevated methemoglobin concentrations, which peaked at 14.7%. Hemolytic anemia developed as evidenced by a fall in blood hemoglobin from 14.8 to 5.3 g/dL. The patient made a full recovery following aggressive fluid therapy, blood transfusions, and respiratory support. G6PD deficiency was subsequently confirmed. The Naranjo probability scale indicated that rasburicase was a probable cause of hemolytic anemia and methemoglobinemia.

DISCUSSION: Rasburicase is contraindicated in patients with G6PD deficiency as it may cause hemolytic anemia and methemoglobinemia. As of September 26, 2005, simultaneous occurrence of hemolytic anemia and methemoglobinemia has not been reported in patients receiving rasburicase.

CONCLUSIONS: As of September 26, 2005, screening for G6PD deficiency should be performed whenever possible prior to chemotherapy administration in patients at risk of developing tumor lysis syndrome.

Key Words: glucose-6-phosphate dehydrogenase deficiency, hemolytic anemia, methemoglobin, rasburicase, uric acid

Published Online, October 4, 2005. www.theannals.com, DOI 10.1345/aph.1G272




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