Wang SW, Zhang XW, Qu JX, Rao YZ, Lu S, Wang B, He J, Zhao Y, Rao BQ. Hemolysis attributed to high dose vitamin C: Two case reports. World J Clin Cases 2024; 12(17): 3168-3176 [PMID: 38898838 DOI: 10.12998/wjcc.v12.i17.3168]
Corresponding Author of This Article
Ben-Qiang Rao, Doctor, MD, PhD, Chief Doctor, Professor, Surgeon, Center for Oncology Nutrition and Metabolism, Beijing Shijitan Hospital, Capital Medical University/Key Laboratory of Cancer FSMP for State Market Regulation, No. 10 Tieyi Road, Yangfangdian, Haidian District, Beijing 100038, China. raobenqiang@bjsjth.cn
Research Domain of This Article
Oncology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Shi-Wan Wang, Xiao-Wei Zhang, Jin-Xiu Qu, Yi-Zhong Rao, Shuai Lu, Bing Wang, Jia He, Yuan Zhao, Ben-Qiang Rao, Center for Oncology Nutrition and Metabolism, Beijing Shijitan Hospital, Capital Medical University/Key Laboratory of Cancer FSMP for State Market Regulation, Beijing 100038, China
Author contributions: Wang SW and Zhang XW participated in patient treatment and summarized patients’ data; Wang SW summarized the data of literature and wrote the manuscript; Qu JX, Lu S, Wang B, He J, Zhao Y and Rao BQ conducted case discussion and treatment analysis; Rao YZ was involved in the creation of the form; Rao BQ guided the research and applied project fund; and all authors have read and approved the final version to be published.
Supported byThe National Natural Science Foundation of China, No. 82074061; The National Key Research and Development Program of China, No. 2022YFC2009600.
Informed consent statement: Both patients and their legal guardians gave verbal consent for the anonymous publication of their conditions, and all care was intended to be curative and not research.
Conflict-of-interest statement: The authors declare that they have no financial or non-financial conflicts of interest that could potentially bias the results or interpretation of their study.
CARE Checklist (2016) statement: The guidelines of the “CARE Checklist – 2016: Information for writing a case report” have been adopted.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ben-Qiang Rao, Doctor, MD, PhD, Chief Doctor, Professor, Surgeon, Center for Oncology Nutrition and Metabolism, Beijing Shijitan Hospital, Capital Medical University/Key Laboratory of Cancer FSMP for State Market Regulation, No. 10 Tieyi Road, Yangfangdian, Haidian District, Beijing 100038, China. raobenqiang@bjsjth.cn
Received: January 24, 2024 Revised: March 4, 2024 Accepted: May 7, 2024 Published online: June 16, 2024 Processing time: 132 Days and 1.2 Hours
Abstract
BACKGROUND
High-dose vitamin C treatment (HVCT) can reduce the adverse effect of chemotherapy and enhance the effect of antitumor therapy, which has been considered one of the safest alternative treatments. However, the severity of its adverse effects may have been underestimated. The most serious adverse effect is hemolysis, which may result in acute kidney injury or death. Although glucose-6-phosphate dehydrogenase (G6PD) deficiency is considered to be the main cause, the probability and pathological mechanism are not completely understood, leading to a lack of effective and standardized treatment methods.
CASE SUMMARY
Two patients with colorectal cancer developed hemolytic anemia after using 1 g/kg HVCT. In contrast to previous cases, the lowest hemoglobin level in the two cases was < 50 g/L, which was lower than previously reported. This may be because Case 1 had chronic hepatitis B for many years, which caused abnormal liver reserve function, and Case 2 had grade II bone marrow suppression. Both patients improved and were discharged after blood replacement therapy. Our cases had the most severe degree of hemolysis but the best prognosis, suggesting that our treatment may be helpful for rescue of drug-induced hemolysis. This is the first review of the literature on hemolysis caused by HVCT, and we found that all patients with G6PD deficiency developed hemolysis after HVCT.
CONCLUSION
G6PD deficiency should be considered as a contraindication to HVCT, and it is not recommended for patients with bone marrow suppression, moderate-to-severe anemia, hematopoietic abnormalities, or abnormal liver and kidney function. Early blood purification and steroid therapy may avoid acute kidney injury or death caused by HVCT-related hemolytic anemia.
Core Tip: Two patients suffered from extremely severe hemolysis after high dose vitamin C treatment (HVCT), and both patients had glucose-6-phosphatase dehydrogenase (G6PD) deficiency. By reviewing the literature and summarizing the findings of available case reports, we conclude for the first time that patients who develop hemolytic anemia after HVCT may have G6PD deficiency, thus G6PD deficiency is an absolute contraindication for HVCT. Our treatment protected the patients from acute kidney injury in the context of extremely severe hemolysis. Our experience may be helpful for the treatment of similar cases.
