Examination of Hydroxychloroquine Use and Hemolytic Anemia in G6PDH‐Deficient Patients

Abstract

This is the largest study to date evaluating G6PDH deficiency with concurrent use of HCQ. Of 11 patients with G6PDH deficiency, 2 had episodes of hemolysis, but these did not occur during HCQ therapy. These data do not support routine measurement of G6PDH levels or withholding HCQ therapy among African American patients with G6PDH deficiency.

COVID‐19 infection and treatment with hydroxychloroquine cause severe haemolysis crisis in a patient with glucose‐6‐phosphate dehydrogenase deficiency

“…However, there is concern regarding haemolysis in G6PD individuals, even though a recent retrospective study did not find a correlation between hydroxychloroquine use and haemolysis in a population with G6PD deficiency and rheumatic disease. 5 Our data demonstrated that severe COVID-19 infection can be the initial trigger of haemolytic crisis in a G6PD-deficient patient.…”

Safety considerations with chloroquine, hydroxychloroquine and azithromycin in the management of SARS-CoV-2 infection

“…In a chart review of 275 rheumatology patients of whom 11 were documented to have G6PD deficiency, no episodes of hydroxychloroquinerelated hemolysis were identified over more than 700 months of treatment. 34 Hematologic abnormalities including lymphopenia, eosinophilia and atypical lymphocytosis can be features of immunologically mediated idiosyncratic drug reactions, as discussed below.…”

Doubtful precipitation of hemolysis by hydroxychloroquine in glucose‐6‐phosphate dehydrogenase‐deficient patient with COVID‐19 infection

“…5 The presumed caution on using hydroxychloroquine in G6PD deficients is not supported by clinical evidence, but by drug information resources and drug package inserts. 6 In an evidence-based review on medications mentioned in 3 major medical textbooks as contraindicated in G6PD deficiency, Youngster et al 7 have concluded that chloroquine monotherapy is safe in G6PD deficients. Notably, William's textbook of hematology considers no contraindications for chloroquine use in G6PD deficients.…”

“…7 It should also be noted that there are currently no available reports of hemolysis in G6PD-deficient individuals with hydroxychloroquine or chloroquine monotherapy. 6,7 Infections are the most common triggers for hemolysis in G6PD deficiency. 7 Given that the index patient with COVID-19 infection had significant hemolysis even before administration of the single dose hydroxychloroquine, along with the lack of previous reports of hemolysis with the same, an association of accentuation of hemolysis with hydroxychloroquine seems unlikely.…”