G6PD Deficiency

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Episodic hemolysis after oxidant (primaquine, dapsone, sulfa, fava, infection)

  1. Smear: bite cells + Heinz bodies (Heinz needs special stain); G6PD assay weeks after episode
  2. Treat: Stop the oxidant; supportive; transfuse if severe

Order set

  • FBC, film (bite cells)
  • Reticulocytes
  • G6PD assay (after episode)
  • Bilirubin, LDH

Criteria

AdmitSevere haemolysis / AKI
TransfuseSevere symptomatic anaemia
DischargeTrigger removed, Hb recovering, counselled
Clinical detail — differentials, red flags, pitfalls, disposition
Red flags
  • Severe hemolysis with hemoglobinuria
  • AKI
Differentials
  • Autoimmune hemolysis
  • Other oxidative hemolysis
Common mistakes
  • Assaying during acute hemolysis (false normal)
  • Re-exposing to oxidant
Disposition & follow-up

Avoid triggers; supportive; genetic counselling.

Discharge package
Medications—
Follow-upCounselling on triggers
LifestyleAvoid oxidant drugs/fava beans
Warning symptomsDark urine, pallor, jaundice after trigger
💊 Treatment detail — doses & preparation
Stop oxidantsdefinitive
DoseWithdraw the trigger: primaquine, rasburicase, sulfa, nitrofurantoin, fava beans
Preparation—
MonitorSelf-limiting once trigger stopped; transfuse only if severe
📖 BSH / WHO G6PDReviewed July 2026

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