Methemoglobinemia and hemolysis in a patient with G6PD deficiency treated with rasburicase

摘要

A 52-year-old African American male was admitted to the hospital for high-dose chemotherapy for refractory aggressive multiple myeloma (MM). He had previously progressed through bortezomib/dexamethasone and lenalidomide therapy. The most recent bone marrow biopsy showed approximately 90% kappa light chain-restricted plasma cells with a high proliferative rate (3.3% cells in S-phase). Admission labs prior to starting any therapy (Table I) were significant for uric acid 16.1 mg/ dL (reference range, 3.7-8.0), creatinine 2.1 mg/dL (reference range, 0.8-1.3 and his baseline was 1.1), lactate dehydrogenase (LDH) 438 U/L (reference range, 122-222), phosphorus 6.2 mg/dL (reference range, 2.5-4.5), hemoglobin 7.1 g/dL (reference range, 13.5-17.5), and IgG kappa monoclonal protein of 4.1 g/dL. On admission, baseline pulse oximetry at the bedside was normal at 95% O2 saturation (SpO2).