Drug-induced haemolysis in glucose-6-phosphate dehydrogenase deficiency.

Chan, Tak-Mao; Todd, D.; Tso, S. C.

doi:10.1136/bmj.2.6046.1227

Cited by 58 publications

(30 citation statements)

References 11 publications

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“…Haemolysis following aspirin ingestion has been documented by chromium survival studies in subjects with G6PD A- [3] or with G6PD Milwaukee [4], as well as in subjects with other variants in South East Asia [5]. However, others have disputed this finding, attributing haemolysis rather to viral infections than to aspirin itself [6,7].…”

Section: Discussionmentioning

confidence: 99%

Aspirin-Induced Acute Haemolytic Anaemia in Glucose-6-Phosphate Dehydrogenase-Def icient Children with Systemic Arthritis

1989

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In a 4-year 7-month-old boy with glucose-6-phosphate dehydrogenase deficiency and systemic arthritis a severe haemolytic anaemia occurred after the administration of acetylsalicylic acid. Erythrocyte fragmentation, with haemoglobin condensation zones next to clear zones, was observed on peripheral blood smears. Since viral or bacterial infections were excluded on the basis of the laboratory data, the anaemia was ascribed to aspirin.

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Section: Discussionmentioning

confidence: 99%

Aspirin-Induced Acute Haemolytic Anaemia in Glucose-6-Phosphate Dehydrogenase-Def icient Children with Systemic Arthritis

1989

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“…In G6PD deficiency, an X-linked disorder, intravascular haemolysis may occur, the severity of which depends on the dose and the degree of enzyme deficiency, which exists in a severe Mediterranean and Asian form and a milder African form (Chan et al 1976). Primaquine is an oxidising agent, and G6PD-deficient red cells have reduced capacity to tolerate oxidant stress, leading to membrane damage and haemolysis.…”

Section: Primaquinementioning

confidence: 99%

Adverse Effects of Antimalarials

Luzzi

Peto

1993

Drug Safety

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Various drugs are widely used in the prophylaxis and treatment of malaria. In the prevention of malaria in travellers, a careful risk-benefit analysis is required to balance the risk of acquiring potentially serious malaria against the risk of harm from the prophylactic agent. Unfortunately, the information needed to perform accurate analyses of this type is not available for most antimalarials. In the prophylaxis of malaria, chloroquine and proguanil have an excellent safety record, being very rarely associated with severe adverse reactions in the recommended dosages. However, in many parts of the world they are no longer effective prophylactic agents. Pyrimethamine-dapsone (Maloprim) is associated with agranulocytosis, especially if the recommended dose is exceeded, and should be reserved as a second-line agent for travellers to high risk areas. Pyrimethamine-sulfadoxine (Fansidar) and amodiaquine are associated with a relatively high incidence of potentially fatal reactions, and are no longer recommended for prophylaxis. Mefloquine, a relative newcomer, may provoke severe neuropsychiatric reactions with a frequency of 1 in 15,000 to 20,000 users at the prophylactic dosage. In the treatment of Plasmodium falciparum malaria, which has a high mortality if untreated, a greater risk of adverse reactions to antimalarial drugs is acceptable. As chloroquine resistance has become widespread, alternative agents including quinine, mefloquine, pyrimethamine-sulfadoxine, tetracyclines, halofantrine and artemisinin (qinghaosu) and its derivatives may be used in treatment regimens. The therapeutic ratios for chloroquine, quinine and mefloquine are narrow and toxicity is frequent when recommended treatment dosages are exceeded; parenteral administration above the recommended dose range is especially associated with the hazards of cardiac and neurological toxicity.

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“…In the blood vessels, antimalarial drugs circulate mainly associated to plasma proteins [3] and are usually quickly removed from circulation, presenting relatively short half-lives from less than one hour to few hours [2]. These shortcomings are usually compensated through administration of increased doses, in a delicate narrow edge between high overall amounts causing toxic side effects [4] and low local concentrations inducing resistance evolution in most malaria-endemic countries [5].…”

Section: Introductionmentioning

confidence: 99%