Hemolysis attributed to high dose vitamin C: Two case reports.
Level 4 - case-series / case-control
Case series of two patients with an accompanying literature review
PubMed 38898838 · doi:10.12998/wjcc.v12.i17.3168
What was done
The authors documented two clinical cases of colorectal cancer patients who developed severe hemolytic anemia after receiving high-dose vitamin C treatment (HVCT) at 1 g/kg, and reviewed existing literature on HVCT-induced hemolysis and glucose-6-phosphate dehydrogenase (G6PD) deficiency.
What was found
Both patients developed severe hemolysis with hemoglobin levels dropping to < 50 g/L following 1 g/kg HVCT. Contributing comorbidities noted were long-standing chronic hepatitis B with abnormal liver reserve function in Case 1 and grade II bone marrow suppression in Case 2. Both patients recovered and were discharged after blood replacement therapy. The authors' literature review identified that all documented patients with G6PD deficiency developed hemolysis following HVCT.
Why it matters
High-dose vitamin C can induce life-threatening hemolysis, emphasizing the critical need to screen for G6PD deficiency prior to treatment and exercise caution in patients with hepatic, renal, or bone marrow impairment.
Limits
This report is limited to two patients (n = 2) and an uncontrolled narrative review. The abstract does not report whether G6PD status was confirmed in these two specific cases, nor does it provide baseline laboratory numbers, timing of onset, or comparative treatment controls.
Cited by
- 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.