Published online Jun 16, 2024. doi: 10.12998/wjcc.v12.i17.3168
Revised: March 4, 2024
Accepted: May 7, 2024
Published online: June 16, 2024
Processing time: 132 Days and 1.2 Hours
High-dose vitamin C treatment (HVCT) can reduce the adverse effect of chemo
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.
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.