Drug Induced Hemolytic Anemia and Glucose-6- Phosphate Dehydrogenase Variants in Malaria

Glucose-6-phosphate dehydrogenase deficiency is a common hemolytic genetic disorder, particularly in the areas endemic to malaria. The risk of drug induced Glucose-6-phosphate dehydrogenase deficiency related hemolysis depends on a number of factors including the Glucose-6-phosphate dehydrogenase variant. Aims: To know the G6PD deficiency and identify its variants in drug induced hemolysis in malaria cases. Settings and Design: Over a period of two years, 106 clinically suspected cases of DIHA, from Visakhapatnam district were reported of which 87 cases (the study group) were diagnosed as malaria. Materials and Methods: Eighty seven cases of malaria with suspected drug induced hemolytic anemia were reported. Hemoglobin levels, reticulocyte counts and serum indirect bilirubin levels were estimated. G6PD deficiency was detected and the enzyme activity in erythrocytes was estimated. The mutation underlying G6PD deficiency was identified. Statistical analysis used: Percentages and p-values were calculated. Results: The severity of hemolysis varied, causing mild hemolysis to transfusiondependent anemia. 31 Glucose-6-phosphate dehydrogenase deficient variants were identified. Glucose-6phosphate dehydrogenase was severely reduced in Mediterranean variant, moderate in Orissa, KeralaKalyan and Namoru variants of the enzyme. Hemolysis was moderate to severe among the individuals with Mediterranean mutation. Hemolysis was moderate among individuals with Namoru mutation and mild with Orissa and Kerala-Kalyan mutations. Conclusions: G6PD deficiency was a common occurrence in our setting. G6PD Mediterranean was the most frequently encountered variant producing severe G6PD deficiency. The frequency correlates with malaria endemicity.