Which medication is most likely to have caused haemolytic anaemia in a patient with G6PD deficiency?

Which medication is most likely to have caused haemolytic anaemia in a patient with G6PD deficiency?

• A. Amoxicillin
• B. Paracetamol
• C. Metformin
• D. Nitrofurantoin

Answer: (D)

In G6PD deficiency, red blood cells cannot generate enough NADPH through the pentose phosphate pathway, so they have impaired levels of reduced glutathione. This makes them vulnerable to oxidative stress because glutathione is what detoxifies reactive oxygen species in the cell. When an oxidant drug is introduced, the oxidative burden overwhelms the RBCs, leading to membrane damage and intravascular or extravascular haemolysis. Nitrofurantoin is an oxidant drug that increases oxidative stress inside red cells. In someone with G6PD deficiency, this extra oxidative hit can trigger haemolysis, making it the most likely cause among the options. The other drugs listed are not known for causing oxidative haemolysis in G6PD deficiency at typical therapeutic doses. Amoxicillin and metformin aren’t strong oxidants that provoke this reaction, and paracetamol, while a potential oxidant in overdose, is not a classic trigger for G6PD-related haemolysis.

In G6PD deficiency, red blood cells cannot generate enough NADPH through the pentose phosphate pathway, so they have impaired levels of reduced glutathione. This makes them vulnerable to oxidative stress because glutathione is what detoxifies reactive oxygen species in the cell. When an oxidant drug is introduced, the oxidative burden overwhelms the RBCs, leading to membrane damage and intravascular or extravascular haemolysis.

Nitrofurantoin is an oxidant drug that increases oxidative stress inside red cells. In someone with G6PD deficiency, this extra oxidative hit can trigger haemolysis, making it the most likely cause among the options.

The other drugs listed are not known for causing oxidative haemolysis in G6PD deficiency at typical therapeutic doses. Amoxicillin and metformin aren’t strong oxidants that provoke this reaction, and paracetamol, while a potential oxidant in overdose, is not a classic trigger for G6PD-related haemolysis.