A 34-year-old immigrant of African origin is prescribed ciprofloxacin for an infection. He suffers problems with acute haemolysis. You suspect G6PD deficiency.
Given this, what is the likely underlying cause of haemolysis?
¨ 選項A、 Increased levels of NADPH
¨ 選項B、 Decreased levels of NADP
¨ 選項C、 A defect on chromosome 29
¨ 選項D、 Reduced levels of ATP
¨ 選項E、 Reduced levels of NADPH
答案解析: E
Glucose 6-phosphate dehydrogenase (G6PD)
Function
+Glucose 6-phosphate dehydrogenase (G6PD) plays a vital role in the hexose monophosphate pathway
+It is involved in the oxidation of glucose 6-phosphate to 6-phosphoglycerate
+This oxidation reaction is needed in red blood cells as it provides the only source of NADPH
+NADPH, in conjunction with glutathione, protects the red blood cell from oxidative stress
Adverse drug interactions in G6PD deficiency
Drugs that may cause an acute haemolytic reaction in people with G6PD deficiency include:
+aspirin
+antimalarials
+antibacterials (including ciprofloxacin and sulphonamides)
+other drugs such as vitamin K, probenecid and quinidine
Acute haemolytic reaction
Blood count is normal between attacks of haemolysis
During an attack the blood film may show:
+irregularly contracted cells bite cells
+blister cells
+Heinz
+bodies reticulocytosis
Treatment is:
+withdrawal of the offending drug
+treatment of any underlying infection
+blood transfusion where required
