"Hemolysis, or not Hemolysis, that is the Question". Use of Hydroxychloroquine in a Patient with COVID-19 Infection and G6PD Deficiency
1 Unit of Hematology and Stem Cell Transplantation, Azienda Ospedaliero-Universitaria Consorziale Policlinico, Bari, Italy.
2 Anaesthesia and Intensive Care Unit II, General surgery, Gynecology and Anaesthesia Department, Azienda Ospedaliero-Universitaria Consorziale Policlinico, Bari, Italy.
3 University of Bari “Aldo Moro”, Emergency and Organ Transplantation department, Bari, Italy.
4 Chair of Hematology and Unit of Hematology and Stem Cell Transplantation, "Aldo Moro" University School of Medicine, Azienda Ospedaliero-Universitaria Consorziale Policlinico, Bari, Italy.
Received: August 18, 2020
Accepted: October 9, 2020
Mediterr J Hematol Infect Dis 2020, 12(1): e2020076 DOI 10.4084/MJHID.2020.076
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To the editor,
|Figure 1. Timeline of blood parameters and treatment.|
Second, the enzymatic activity deficiency is not a predictive parameter of the severity of the clinical condition, as we reported in 2001. Although it is not yet clearly understood whether genetic or extragenetic, other mechanisms must exist that offer protection from the oxidative stresses that play a role in the clinical expression of G6PD deficiency. Third, since G6PD-deficiency could be a susceptibility factor to SARS-CoV2 infection and that this inherited abnormality is not so rare, it should be sought in case of unexplained hemolysis or before administering drugs, a potential trigger of hemolysis. According to literature data, we recommend caution with using HCQ in all subjects with G6PD-deficiency, including those with COVID-19 infection; at the same time, we believe that the use of this drug in patients with G6PD deficiency should be investigated with further studies, elucidating the role of residual enzyme activity and genotype, factors that may influence AHA risk. Moreover, although G6PD deficiency remains a contraindication to HCQ use, our report suggests that several variables may influence AHA risk, and these aspects should be investigated in further studies to discriminate patients who may have some benefits from this specific drug.
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