Indian Journal of Critical Care Medicine

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 22 , ISSUE 9 ( 2018 ) > List of Articles


Hepatitis A Virus-induced Severe Hemolysis Complicated by Severe Glucose-6-Phosphate Dehydrogenase Deficiency

Shashank Shekhar, Suneel Garg

Keywords : Glucose-6-phosphate dehydrogenase deficiency, hemolytic anemia, hemoperfusion, hepatitis A, methemoglobinemia, multiorgan failure

Citation Information : Shekhar S, Garg S. Hepatitis A Virus-induced Severe Hemolysis Complicated by Severe Glucose-6-Phosphate Dehydrogenase Deficiency. Indian J Crit Care Med 2018; 22 (9):670-673.

DOI: 10.4103/ijccm.IJCCM_260_18

License: CC BY-ND 3.0

Published Online: 01-05-2015

Copyright Statement:  Copyright © 2018; The Author(s).


Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an x-linked recessive genetic disorder with mutation in the G6PD gene. Defect in the enzyme G6PD causes red blood cells (RBCs) to breakdown prematurely causing hemolytic anemia. Hemolytic anemia is also a known hematological complication associated with viral hepatitis. In such patients, hemolysis may be more severe if there is any secondary injury to RBC in the form of membrane defect, oxidative stress, or enzyme deficiency like in G6PD deficiency. Here, we present a case of an adult, not previously diagnosed with G6PD deficiency, who presented with viral hepatitis, severe hemolysis, and multiorgan failure.

PDF Share
  1. Cappellini MD, Fiorelli G. Glucose-6-phosphate dehydrogenase deficiency. Lancet 2008;371:64-74.
  2. Frank JE. Diagnosis and management of G6PD deficiency. Am Fam Physician 2005;72:1277-82.
  3. Luzzatto L, Nannelli C, Notaro R. Glucose-6-phosphate dehydrogenase deficiency. Hematol Oncol Clin North Am 2016;30:373-93.
  4. Manganelli G, Masullo U, Passarelli S, Filosa S. Glucose-6-phosphate dehydrogenase deficiency: Disadvantages and possible benefits. Cardiovasc Hematol Disord Drug Targets 2013;13:73-82.
  5. Nkhoma ET, Poole C, Vannappagari V, Hall SA, Beutler E. The global prevalence of glucose-6-phosphate dehydrogenase deficiency: A systematic review and meta-analysis. Blood Cells Mol Dis 2009;42:267-78.
  6. Chan TK, Todd D. Haemolysis complicating viral hepatitis in patients with glucose-6-phosphate dehydrogenase deficiency. Br Med J 1975;1:131-3.
  7. Salen G, Goldstein F, Haurani F, Wirts CW. Acute hemolytic anemia complicating viral hepatitis in patients with glucose-6-phosphate dehydrogenase deficiency. Ann Intern Med 1966;65:1210-20.
  8. Hargrove MD. Marked increase in serum bilirubin in sickle anemia: A report of six cases. Am J Dig Dis 1970;15:437.
  9. WHO Working Group. Glucose-6-phosphate dehydrogenase deficiency. WHO working group. Bull World Health Organ 1989;67:601-11.
  10. Tripathy V, Reddy BM. Present status of understanding on the G6PD deficiency and natural selection. J Postgrad Med 2007;53:193-202.
  11. Ho L, John RM. Understanding and managing glucose-6-phosphate dehydrogenase deficiency. J Nurse Pract 2015;11:443-50.
  12. Gotsman I, Muszkat M. Glucose-6-phosphate dehydrogenase deficiency is associated with increased initial clinical severity of acute viral hepatitis A. J Gastroenterol Hepatol 2001;16:1239-43.
  13. Charan VD, Desai N, Choudhury VP. Hyperbilirubinemia following hepatitis A in a patient with G6pD deficiency. Indian J Gastroenterol 1993;12:99.
  14. Agarwal RK, Moudgil A, Kishore K, Srivastava RN, Tandon RK. Acute viral hepatitis, intravascular haemolysis, severe hyperbilirubinaemia and renal failure in glucose-6-phosphate dehydrogenase deficient patients. Postgrad Med J 1985;61:971-5.
  15. Li M, Wang Z, Wang Y, Du C, Li S, Shi Z, et al. Part of plasmapheresis with plasma filtration adsorption combined with continuous hemodiafiltration in the treatment of severe acute liver failure. Exp Ther Med 2016;12:2582-4.
  16. Huo TI, Wu JC, Chiu CF, Lee SD. Severe hyperbilirubinemia due to acute hepatitis A superimposed on a chronic hepatitis B carrier with glucose-6-phosphate dehydrogenase deficiency. Am J Gastroenterol 1996;91:158-9.
  17. Hosnut FO, Ozcay F, Bayrakci US, Avci Z, Ozbek N. Etiology of hemolysis in two patients with hepatitis A infection: Glucose-6-phosphate dehydrogenase deficiency or autoimmune hemolytic anemia. Eur J Pediatr 2008;167:1435-9.
  18. Lanjuan L; Liver Failure and Artificial Liver Group; Society of Infectious Diseases; Chinese Medical Association. Guidelines for non-bioartificial liver support system in treatment of liver failure: 2016 edition. Chin J Clin Infect Dis 2016;9:97-109.
  19. Li M, Sun J, Li J, Shi Z, Xu J, Lu B, et al. Clinical observation on the treatment of acute liver failure by combined non-biological artificial liver. Exp Ther Med 2016;12:3873-6.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.