Vitamin C-induced Hemolysis: Meta-summary and Review of Literature.
Level 4 - case-series / case-control
Systematic review/meta-summary aggregating individual case reports
PubMed 35712748 · doi:10.5005/jp-journals-10071-24111
What was done
Systematic literature search of PubMed, Science Direct, and Google Scholar from January 1975 to July 31, 2021, identifying case reports of vitamin C-induced hemolysis. Patient demographics, dosing, duration, route, outcomes, and underlying conditions were extracted.
What was found
Fourteen case reports were included (ages 3 weeks to 75 years; 78.6% male). Vitamin C doses ranged from 1 to 200 g/day (57.1% intravenous; 57.1% prescribed for nutritional supplementation). About 71.4% were diagnosed with G6PD deficiency, but only 2 had prior documented hemolysis. Complications occurred within 3 days in 78.6% of patients; 50% developed additional complications (acute kidney injury, disseminated intravascular coagulation, oxalosis, and methemoglobinemia). One death was reported.
Why it matters
Highlights that high-dose vitamin C can trigger acute, life-threatening hemolysis and associated multi-organ complications, particularly in patients with G6PD deficiency.
Limits
Based solely on 14 retrospective case reports subject to substantial publication and reporting bias. Lacks controls, preventing incidence or risk estimation.
Cited by
- supports Patients with glucose-6-phosphate dehydrogenase deficiency are at risk of hemolysis when given intravenous vitamin C doses of 40 g or higher.
- contradicts Case reports indicate that intravenous vitamin C at doses between 1 to 10 g reduced hemolysis in patients with glucose-6-phosphate dehydrogenase deficiency.