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Pain Management 2018
Internal Medicine 2018
International Journal of Anesthesiology & Pain Medicine
ISSN: 2471-982X
Page 55
March 26-28, 2018
Vienna, Austria
JOINT EVENT
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E d i t i o n o f I n t e r n a t i o n a l C o n f e r e n c e o n
Internal Medicine and Patient Care
&
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E d i t i o n o f I n t e r n a t i o n a l C o n f e r e n c e o n
Pain Management
Volume 4
Background:
G6PD deficiency is common in Mediterranean
countries and is associated with favism, i.e., hemolytic anemia
following consumption of fava beans. Given it is an x-linked
recessive inherited disorder, it is uncommon in women.
Case Report:
A 74-year-old female presented due to jaundice
that developed in the past 24 hours. Her oxygen saturation on
pulse oximetry was 86%, while her arterial blood gases showed
a saturation of 94.7%. Lab tests revealed a hemolytic anemia
(hemoglobin 9.4 mg/dl, 2.5% reticulocytes, LDH 582U/l, total
bilirubin 8.4mg/dl, conjugated bilirubin 1.25mg/dl, normal
coagulation times, normal platelet count and negative direct
coombs). She denied taking any new medications. She reported
consumption of fava beans the day before, although she reported
uneventful prior consumption 2 years ago. Family history taking
revealed that she had a son diagnosed with G6PD deficiency.
G6PD deficiency was confirmed with quantitative testing
(enzyme activity 6.7U/g Hb, normal range 7-16). During the first
day the hematocrit fell to 21.8%, with 25% reticulocytes. She was
managed with intravenous hydration and blood transfusion. The
hematocrit rapidly rose, pulse oximetry saturation normalized,
and she was discharged with a diagnosis of favism.
Discussion:
Favism may occur in elderly women with
heterozygous G6PD deficiency despite normal prior consumption
of fava beans. This may happen due to skewed X-chromosome
inactivation with aging, affecting the wild-type allele. The low
oxygen saturation on pulse oximetry can be explained by favism
associated methemoglobinemia, as previously described.
Recent Publications
1. Nkhoma E T, Poole C, Vannappagari V, Hall S A and
Beutler E (2009) The global prevalence of glucose-6-
phosphate dehydrogenase deficiency: a systematic
review and meta-analysis. Blood Cells, Molecules and
Diseases 42:267-78.
2. AuWY, LamV, PangA, et al. (2006) Glucose-6-phosphate
dehydrogenase deficiency in female octogenarians,
nanogenarians, and centenarians. J Gerontol A Biol Sci
Med Sci. 61:1086-9.
3. Hassan K S, Al-Riyami A Z, Al-Huneini M, Al-Farsi K and
Al-Khabori M (2014) Methemoglobinemia in an elderly
patient with glucose-6-phosphate dehydrogenase
deficiency: a case report. Oman Medical Journal 29:135-
7.
4. Schuurman M, van Waardenburg D, Da Costa J,
Niemarkt H and Leroy P (2009) Severe hemolysis and
methemoglobinemia following fava beans ingestion
in glucose-6-phosphatase dehydrogenase deficiency:
case report and literature review. European Journal of
Pediatrics 168:779-82.
Biography
Stamatis Karakonstantis, Kalliopi Milaki, Dafni Korela, Sofia Pitsigavdaki,
Ifigeneia Kassotaki and Despoina Galani
General Hospital of Heraklion “Veni-
zeleio-Pananeio”,
Greece Stamatis Karakonstantis is a resident of Internal
Medicine. He graduated from the Medical Faculty of the University of Crete,
in Heraklion and completed an MRes degree from the University of Birming-
ham. He is a new author and has so far published 8 manuscripts.
stamkar2003@gmail.comFavism in an elderly female associated with low pulse
oximetry saturation and a history of normal prior
consumption of fava beans
Stamatis Karakonstantis, Kalliopi Milaki, Dafni Korela, Sofia Pitsigavdaki, Ifigene-
ia Kassotaki
and
Despoina Galani
General Hospital of Heraklion “Venizeleio-Pananeio”, Greece
Stamatis Karakonstantis et al., Int J Anesth Pain Med 2018, Volume 4
DOI: 10.21767/2471-982X-C1-003