Clinical Report: A Rare Case of Acute Hemolysis After Rasburicase Infusion

Overview

This report details a case of acute hemolysis in a patient with chronic lymphocytic leukemia following rasburicase infusion. The hemolysis was attributed to undiagnosed G6PD deficiency, highlighting the importance of screening prior to administering rasburicase.

Background

Acute hemolysis can occur as a serious complication in patients receiving treatments for hematologic malignancies, particularly those at risk for tumor lysis syndrome. Rasburicase is effective in lowering uric acid levels but is contraindicated in patients with G6PD deficiency due to the risk of hemolysis. Understanding the implications of G6PD deficiency in this context is crucial for patient safety.

Data Highlights

Key Findings

• The patient developed acute hemolysis after receiving rasburicase due to undiagnosed G6PD deficiency.
• Initial symptoms included dark brown urine, jaundice, and fatigue, leading to emergency department presentation.
• Laboratory tests confirmed hemolysis with elevated bilirubin and decreased hemoglobin levels.
• The patient was treated with intravenous fluids and high-dose steroids, resulting in improved laboratory values.
• Rasburicase is contraindicated in patients with G6PD deficiency due to the risk of severe hemolysis.
• Prophylactic measures, including hydration and uric acid-lowering agents, are essential in high-risk patients receiving venetoclax.

Clinical Implications

Healthcare providers should screen for G6PD deficiency in patients at risk before administering rasburicase. Prophylactic hydration and uric acid-lowering agents should be utilized in patients receiving venetoclax to mitigate the risk of tumor lysis syndrome.

Conclusion

Reinforce the critical need for G6PD screening prior to rasburicase administration.

References

1. Richardson & O’Malley, 2024 -- A Rare Case of Acute Hemolysis After Rasburicase Infusion
2. Barcellini, 2024 -- G6PD Deficiency and Hemolytic Anemia
3. Mahfooz, 2023 -- G6PD Deficiency Overview
4. Critical Care (Springer) — Severe autoimmune hemolytic anemia in ICU: a place for emergency plasma exchange? A French multicenter retrospective study
5. Infection — Management of Hemoptysis in a Multidrug-Resistant Tuberculosis Patient: Effective Diagnosis via Photon Counting CT and Treatment of a Rasmussen Aneurysm
6. The ASCO Post — Microangiopathic Hemolytic Anemia and Thrombocytopenia Related Articles
7. Blood Cancer Journal — CALRins5-mediated clonal hematopoiesis causes severe hemolytic anemia in a female PGK1Ser320Asn carrier
8. Tumor Lysis Syndrome - StatPearls
9. DailyMed - ELITEK- rasburicase kit