Hydroxychloroquine

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Acute intravascular haemolytic anaemia following off-label use: case report A 51-year-old man developed acute intravascular haemolytic anaemia following off label use of hydroxychloroquine for COVID-19 pneumonia. The man, who had a history of hypertension, morbid obesity and type 2 diabetes mellitus, presented with myalgias, fever, worsening shortness of breath and dry cough on 31 March 2020. One week prior to the presentation, he was diagnosed with community-acquired pneumonia and had completed a 7 day course of levofloxacin. On current admission, he tested positive for COVID-19. Following examinations, a diagnosis of COVID-19 pneumonia was made. On day 1 i.e on 1 April 2020, he started receiving hydroxychloroquine 400mg twice daily and 400mg once daily on days 2–4 for a total of 5 days [route not stated]. Gucose-6-phosphate dehydrogenase (G6PD) deficiency testing was done on admission, which was found to be negative, but on day 6 i.e on 6 April 2020, the testing was abnormal. He was also found to have elevated creatine kinase and creatinine level which were consistent with acute kidney injury. He was managed with unspecified fluids initially but later required haemodialysis. On day 6 of admission, he became hypoxic, and developed lethargy and dyspnea with decrease in haemoglobin level to 8.4 g/dL (on admission 14.5 g/dL). He required oxygen supplement. Laboratory tests in the subsequent 3 days showed a reticulocytosis of more than 3%, elevated LDH level to 2575 U/L, elevated total bilirubin level to 1.5 mg/dL (0.3 mg/dL on admission) with relatively unchanged direct bilirubin levels (maximum = 0.4 mg/dL throughout admission), positive schistocytes on a peripheral blood film and low haptoglobin concentration to less than 10 mg/dL suggestive of an acute intravascular haemolytic anaemia. The man was treated with RBC transfusions on days 9, 10 and 11 of admission i.e from 9 April 2020 to 11 April 2020. The haemoglobin level was 5.9, 6.7 and 6.6 g/dL on 9 April 2020, 10 April 2020 and 11 April 2020, respectively. The haemodialysis catheter were clogged twice during the haemolytic process, which required 2 separate catheter replacement. On day 16 of admission i.e on 16 April 2020, he was able to breathe comfortably with haemoglobin level at 8.6 g/dL. On 21 April 2020, he was discharged from hospital with outpatient haemodialysis scheduled for ongoing acute kidney injury. Aguilar J, et al. Hemolytic Anemia in a Glucose-6-Phosphate Dehydrogenase-Deficient Patient Receiving Hydroxychloroquine for COVID-19: A Case Report. Permanente 803520227 Journal 24: no pagination, 2020. Available from: URL: http://doi.org/10.7812/TPP/20.158

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Reactions 12 Dec 2020 No. 1834