A Case Report of Haemolysis in a G6PD Deficient Child due to Acetaminophen Overdose Resulted from Parental Unawareness

Although acetaminophen is considered a low-risk analgesic and antipyretic drug in Glucose-6-Phosphate Dehydrogenase Deficiency (G6PDD) patients, cases of haemolysis following acetaminophen overdose have been published in the literature. An eleven-month-old boy was admitted to the paediatrics department of the hospital with the complaints of haematuria and yellowish discolouration of the eyes since one day. He had been previously diagnosed as glucose-6-phosphate dehydrogenase deficiency. Unknowingly the mother of the child simultaneously given three different brands of acetaminophen prescribed by different paediatricians at various times resulted in an overdose of acetaminophen. On admission, the child had haemoglobin of 4 g/dl. The laboratory results were suggestive of haemolytic process. Direct Coombs test was negative. Acetaminophen overdose was the most likely cause of the haemolysis. The child was managed conservatively and no further episodes of haematuria was observed. Naranjo and WHO causality assessments were done, indicating a probable relationship between the patient’s symptoms and the use of acetaminophen. Acetaminophen overdose induced haemolysis due to G6PD deficiency is an unusual complication which is generally reported in children. The majority of G6PD deficiency individuals remains asymptomatic until a trigger (Infection, drugs and fava beans) induces haemolysis. We document a case report of acetaminophen overdose induced haemolysis in a baby with G6PD deficiency and conclude that there is a need for parental education about the drugs that can trigger haemolysis in G6PD deficient children and also about the different brands of the same drug available in the market. Key words: Acetaminophen, Paracetamol, NSAIDs, G6PD deficiency, Haemolysis, Anaemia.