Methylene blue unresponsive methemoglobinemia

Abstract

Acquired methemoglobinemia is an uncommon blood disorder induced by exposure to certain oxidizing agents and drugs. Although parents may not give any history of toxin ingestion; with the aid of pulse-oximetry and blood gas analysis, we can diagnose methemoglobinemia. Prompt recognition of this condition is required in emergency situations to institute early methylene blue therapy. We report an unusual case of severe toxic methemoglobinemia, which did not respond to methylene blue, but was successfully managed with exchange transfusion.

A perfect storm: Tumor lysis syndrome with rasburicase‐induced methemoglobinemia in a G6PD deficient adult

“…In addition to our patient, four case reports in the literature describe successful whole blood or red cell exchange transfusion for refractory methemoglobinemia [2][3][4][5][6]; one was in a pediatric patient with rasburicase-induced methemoglobinemia [4]. No adverse events have been reported, but exchange transfusion is not without risk.…”

“…Continuous ascorbic acid treatment was initiated, but methemoglobin remained persistently elevated (12.9-14.6%) over the next 48 h. The transfusion medicine service was consulted to assess the patient for possible red cell exchange. The American Society for Apheresis (ASFA) 2013 guidelines regarding the use of therapeutic apheresis do not address refractory methemoglobinemia [3], but transfusion exchange has been performed successfully in at least three cases [4][5][6]. The decision was made to perform a 1600 mL (1 red cell volume) automated red cell exchange via right internal jugular central venous catheter, resulting in a decrease in the patient's methemoglobin to 8.0%, a 45% reduction.…”

Survival after severe methemoglobinemia secondary to sodium nitrate ingestion

“…Methylene blue is not typically used in patients with G6PD deficiency due the possibility of hemolysis [1,6]. Exchange transfusion and hyperbaric oxygen therapy are alternative treatments to methylene blue in the setting of allergy, hypersensitivity, history of adverse reactions to methylene blue, or G6PD deficiency with hemolysis [1,6,8,14].…”

Noninvasive photoacoustic microscopy of methemoglobinin vivo

“…7,8 Usually used as a treatment for methemoglobinemia, methylene blue can worsen the condition in individuals with endogenous glucose-6-phosphate dehydrogenase deficiency. 9,10 In this case, fast measurement of the spatial distribution of methemoglobin around the area where anesthetics are applied enables surgeons to react quickly by revealing the concentration change of methemoglobin following the treatment. Moreover, measuring methemoglobin's spatial distribution provides additional information for differential diagnoses in patients with mechanical airway obstruction, pulmonary embolus, or circulatory shock, 4 and in infants with cyanotic congenital heart diseases or sepsis.…”