Hemolysis attributed to high dose vitamin C: Two case reports

Table 2 Cases of hemolysis attributed to intravenous high-dose vitamin C treatment

Year	Nationality	Sex	G6PD deficiency	Dose, g/d	The lowest level of hemoglobin, g/L	Treatment	Complications and prognosis	Ref.
1975	United States	M	Yes	80	58	Blood transfusion + glucocorticoids (day 3) + hemodialysis (after anuria)	AKI, DIC, death	[19]
1993	United Kingdom	M	Yes	80	67	Drink plenty of water + folic acid orally	AKI	[20]
2014	Taiwan, China	M	Yes	75	54	Supportive treatment	None	[21]
2017	United States	M	Yes	60	59	Intravenous fluids + glucocorticoids	AKI, methemoglobinemia, acute oxalate nephropathy	[22]
2019	United States	M	Yes	65-200	-	-	None	[23]
2020	Hong Kong, China	F	Yes	30	63	Blood transfusion	Methemoglobinemia	[6]
2022	Taiwan, China	M	Yes	50	71	-	AKI	[24]
2023	Mainland China	M	Yes	90	37	Plasmapheresis + glucocorticoids	Methemoglobinemia	This text
2023	Mainland China	F	Yes	60	41	Hemofiltration + glucocorticoids	Methemoglobinemia	This text

All patients who developed hemolysis after HVCT had G6PD deficiency, and two patients reported here had lower hemoglobin levels than previous patients, and no serious complications occurred after early blood transfusion and hormone therapy. G6PD: Glucose 6 phosphate dehydrogenase; M: Male; F: Female; AKI: Acute kidney injury; DIC: Disseminated intravascular coagulation.