Chokri Ben Lamine: Approach to Intra-Operative Bleeding in G6P Deficiency – Key Causes and Management
Chokri Ben Lamine, Adult Hematology and Stem Cell Transplantation Assistant Consultant at Oncology Center of Excellence at King Faisal Specialist Hospital and Research Center, shared a post on X:
“G6PD Deficiency and Intra-Operative Bleeding
Differential Diagnosis (DDx)
Not always due to G6PD deficiency itself! Think:
•Oxidative drug exposure (e.g., sulfa, quinolones, methylene blue) → acute hemolysis → anemia → bleeding risk
• Sepsis / stress → hemolysis
•Coagulopathy unrelated to G6PD (DIC, liver dysfunction, massive transfusion effect)
•Surgical/technical bleeding cause
•Platelet dysfunction (drugs, uremia)
•Vitamin K deficiency / anticoagulant exposure
Approach
•Stabilize – secure hemodynamics, transfuse PRBC/FFP/platelets as indicated
•Stop oxidative triggers – avoid sulfa, dapsone, quinolones, methylene blue
•Investigate – CBC, retics, LDH, haptoglobin, bilirubin, smear (Heinz bodies, bite cells )
•Correct coagulopathy – INR/PTT, fibrinogen → give FFP, cryo as needed
•Rule out surgical cause – surgical hemostasis review
•Support – hydration, urine alkalinization if hemolysis with hemoglobinuria
•Consult hematology – intra-op support plan, transfusion thresholds
Key Pearl:
Bleeding in G6PD deficiency intra-op is usually secondary to oxidant-induced hemolysis + anemia or unrelated acquired coagulopathy, not a primary platelet/clotting defect.”
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