Faculty Collaboration Database

High prevalence of Dapsone-induced oxidant hemolysis in North American SCT recipients without glucose-6-phosphate-dehydrogenase deficiency. Bone Marrow Transplant 2012 Mar;47(3):399-403

Date

04/12/2011

Pubmed ID

21478917

DOI

10.1038/bmt.2011.83

Scopus ID

2-s2.0-84858075288 (requires institutional sign-in at Scopus site)   16 Citations

Abstract

Dapsone (4-4'-diaminodiphenylsulfone) is commonly used for Pneumocystis jirovecii pneumonia (PCP) prophylaxis in immunocompromised patients. Oxidant hemolysis is a known complication of dapsone, but its frequency in adult patients who have undergone a SCT for hematological malignancies is not well established. We studied the presence of oxidant hemolysis, by combining examination of RBC morphology and laboratory data, in 30 patients who underwent a SCT and received dapsone for PCP prophylaxis, and compared this group with 26 patients who underwent a SCT and received trimethoprim-sulfamethoxazole (TMP-SMX) for PCP prophylaxis. All patients had normal glucose-6-phosphate dehydrogenase (G6PDH) enzymatic activity. In SCT patients, dapsone compared with TMP-SMX for PCP prophylaxis was associated with a high incidence of oxidant hemolysis (87 vs 0%, P<0.001), and the morphological evaluation of oxidant hemolysis correlated well with laboratory evidence of hemolysis. Dapsone-induced oxidant hemolysis in SCT patients is 20-fold higher than the reported rate in the population of HIV-infected patients, and thus much higher than the prevalence of G6PDH variants in the general population. In our patients, it manifested clinically as a lower Hb that was not significant enough to result in increased packed RBC transfusions.

Author List

Olteanu H, Harrington AM, George B, Hari PN, Bredeson C, Kroft SH

Authors

Parameswaran Hari MD Adjunct Professor in the Medicine department at Medical College of Wisconsin
Alexandra M. Harrington MD Professor in the Pathology department at Medical College of Wisconsin
Steven Howard Kroft MD Chair, Professor in the Pathology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Anti-Infective Agents
Dapsone
Female
Glucosephosphate Dehydrogenase
Glucosephosphate Dehydrogenase Deficiency
Hemoglobins
Hemolysis
Humans
Male
Middle Aged
North America
Oxidants
Prevalence
Retrospective Studies
Stem Cell Transplantation
Time Factors
Trimethoprim, Sulfamethoxazole Drug Combination