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2 out of 3

Which doesn’t cause hemolysis in G6PD deficiency: (AIIMS May 2009)

A Oestrogen
B Salicylates

C Primaquine
D Nitrofurantoin

Ans. A


Clinical features

Acute drug- induced haemolysis

Drugs that Carry Risk of Clinical Hemolysis in Persons with G6PD Deficiency

(Ref. Hari-. 18th ed., Pg. 878, Table 106-5)

1. Primaquine

2. Dapsone

3. Sulphametoxazole

4. Cotrimoxazole

5. Nalidixic acid

6. Nitrofurantoin

7. Niridazole

Laboratory features

Non-spherocytic intravascular haemolysis during an attack

1. The blood film will show:

a. Bite cells (Red cells with a ‘bite’ of membrane missing)

b. Blister cells (Red cells with surface blistering of the membrane)

c. Irregularly shaped small cells

d. Polychromasia reflecting the reticulocytosis

e. Denatured haemoglobin visible as Heinz bodies within the red cell cytoplasm, if stained with a supravital stain such as methyl violet

2. G6PD level

a. Can be indirectly assessed by screening methods which usually depends upon the decreased ability to reduce dyes.

b. Direct assessment of G6PD is made in those with low screening values

c. Care must be taken close to an acute haemolytic episode because reticulocytes may have normal enzyme levels and give rise to a false normal result.