اثر تزریق ویتامین C با دوز بالا در بیماران مبتلا به کمبود گلوکز 6 فسفات دی هیدروژنیزه Effect of High-Dose Vitamin C Infusion in a Glucose-6-Phosphate Dehydrogenase-Deficient Patient

1. Introduction Vitamin C is a water-soluble vitamin that is generally regarded as a benign medical intervention if supplemented. )ough the bene9ts of vitamin C have been extolled for many years, there has been a resurgence of interest in the general medical community regarding the use of vitamin C most notably in the care of sepsis. For most patients, supplementing with vitamin C is benign. However, there remain patient populations for which caution must be used if vitamin C supplementation is being administered at levels that are considered supraphysiologic. We present a case of hemolysis in a glucose-6-phosphate dehydrogenase- (G6PD-) de9cient patient receiving vitamin C infusions for his rheumatoid arthritis. 2. Case Presentation A 59-year-old African American male with a past medical history of chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL), hypertension, and rheumatoid arthritis presented from an outside facility with symptomatic anemia and white blood cell elevation that was noted to be predominately lymphocytic. He had a known history of CLL/SLL via lymph node biopsy that was diagnosed three months prior to admission. At the outside facility, he was noted to be hypoxic and required four liters of oxygen/minute to maintain oxygen saturation above 85%. An arterial blood gas (ABG) was performed demonstrating a pH of 7.53, pCO2 of 32 mmHg, and a PaO2 of 550 mmHg while on 4 L/min of oxygen. Methemoglobin and carboxyhemoglobin levels were automatically drawn as part of the ABG assay. )is revealed a methemoglobinemia of 5.9% and a carboxyhemoglobin elevation of 4%. Other labs demonstrated a hemoglobin level of 5.9 g/dL with an elevation of his white blood cell count to 53.10 k/uL. He was also noted to have an elevated lactate dehydrogenase and reduced haptoglobin level concerning for intravascular hemolysis. Due to his history of CLL/SLL, there was a concern that his anemia was due to CLL marrow in9ltration or an autoimmune hemolytic anemia. )e patient was subsequently transferred to our facility for further management.