SHM Converge Scientific Abstract ePoster Gallery-Sulfonylurea Induced Hemolytic Anemia in G6pd Deficiency

Pdf Summary

A 44-year-old man with poorly controlled diabetes and orthostatic hypotension developed worsening dizziness three days after starting metformin, pioglitazone, and glipizide. In the emergency department, he was tachycardic and hypotensive but improved with IV fluids. Laboratory studies showed acute non-immune hemolytic anemia, with a rapid hemoglobin drop, elevated reticulocyte count and LDH, low haptoglobin, and negative Direct Coombs and other tests for alternative causes of hemolysis.<br /><br />He received one unit of packed red blood cells and all oral diabetes medications were stopped. His hemoglobin stabilized. Further testing revealed low G6PD enzyme activity, and the patient then recalled a previous diagnosis of G6PD deficiency from army screening.<br /><br />The case was attributed to sulfonylurea-induced hemolysis, most likely triggered by glipizide. Metformin and pioglitazone were considered unlikely causes. This is a rare but important adverse drug reaction, and reported cases have generally occurred in patients with previously undiagnosed G6PD deficiency. The report emphasizes that hemolysis in G6PD deficiency can occur within 24–72 hours of exposure to a trigger and that suspected oxidizing drugs should be permanently discontinued because rechallenge is unsafe.<br /><br />The case also highlights a transition-of-care and patient safety issue: clinicians should ask about G6PD deficiency before prescribing medications that may cause oxidative stress, even drugs such as glipizide that are generally considered low risk. Acute hemolysis can also falsely lower HbA1c, potentially complicating diabetes management.

Asset Subtitle

Ashutosh Upadhyaya

Meta Tag

Author List Ashutosh Upadhyaya, Deepa Mary Cheriyan, Kahee A. Mohammed

Category Clinical Vignettes

Concept Sulfonylureas

Concept Acute Hemolytic Anemia

Concept Glucose-6-Phosphate Dehydrogenase Deficiency

Concept Adverse Drug Reaction

Concept Hemolysis

Distinguished Non-Finalist

Presenter Organization SSM Health St. Mary's Hospital

Presenting Author Ashutosh Upadhyaya

Track Adult

Keywords

G6PD deficiency

glipizide

sulfonylurea-induced hemolysis

acute hemolytic anemia

metformin

pioglitazone

diabetes mellitus

oxidative stress

Direct Coombs negative

HbA1c artifact

Sulfonylureas

Acute Hemolytic Anemia

Glucose-6-Phosphate Dehydrogenase Deficiency

Adverse Drug Reaction

Hemolysis