1例未识别的葡萄糖-6-磷酸脱氢酶缺乏症患者静脉注射高剂量维生素C诱导高铁血红蛋白血症和急性溶血

F. Fimognari, V. Bambara, P. Scarpino, O. Cuccurullo, Roberto Ricchio, Claudio Iorio, M. Rizzo
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引用次数: 0

摘要

在葡萄糖-6-磷酸脱氢酶缺乏症(favism)中,暴露于氧化剂可引发溶血危机。静脉注射高剂量维生素C被提议作为治疗2019年严重冠状病毒病(COVID-19)肺炎的一种方法。与低剂量维生素C不同,高剂量维生素C(每天60克)可促进H2O2的形成,促进血红蛋白氧化为高铁血红蛋白,并最终导致蚕豆病患者的溶血性贫血。我们在这里描述了一名77岁男性因严重COVID-19肺炎住院的病例,并在前6天内接受平均每日剂量9.5克静脉注射维生素C的治疗。他出现了高铁血红蛋白血症和溶血性贫血,在中断维生素C治疗后好转。以前未被发现的葡萄糖- 6-磷酸脱氢酶缺乏症被诊断出来。COVID-19患者中第一例维生素引起的溶血性贫血表明,在使用非常高剂量的维生素C或长期治疗之前,需要筛查葡萄糖-6-磷酸脱氢酶缺乏症。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Methemoglobinemia and acute hemolysis induced by high intravenous doses of vitamin C in a COVID-19 patient with unrecognized glucose-6- phosphate-dehydrogenase deficiency
In glucose-6-phosphate-dehydrogenase deficiency (favism), exposure to oxidant agents can trigger hemolytic crises. The intravenous administration of very high doses of vitamin C was proposed as a treatment for severe coronavirus disease 2019 (COVID-19) pneumonia. Unlike low vitamin C doses, very high doses (>6 gr daily) can promote H2O2 formation, oxidation of hemoglobin to methemoglobin and, eventually, hemolytic anemia in patients with favism. We here describe the case of a 77-year old man hospitalized for severe COVID-19 pneumonia and treated with a mean daily dose of 9.5 gr of intravenous vitamin C during the first 6 days. He developed methemoglobinemia and hemolytic anemia, which improved after interruption of vitamin C treatment. Previously unrecognized glucose- 6-phophate-dehydrogenase deficiency was diagnosed. This first case of vitamin Cinduced hemolytic anemia in a COVID-19 patient indicates the need of a screening for glucose-6-phosphate-dehydrogenase deficiency before treatment with very high vitamin C doses or for long period.
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