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MoonDragon's Obgyn Information
G6PD Deficiency Anemia
(Glucose-6-phosphate dehydrogenase deficiency)


"For Informational Use Only"
For more detailed information contact your health care provider
about options that may be available for your specific situation.




BASIC INFORMATION


DESCRIPTION

Other names this disease is known by G-6-PD deficiency; Hemolytic anemia due to G6PD deficiency; Anemia - hemolytic due to G6PD deficiency

G-6-PD deficiency is a hereditary, sex-linked enzyme defect that results in the breakdown of red blood cells when the person is exposed to the stress of infection or certain drugs.

normal blood cells
Normal Blood Cells





FREQUENT SIGNS & SYMPTOMS

  • Fatigue
  • Pale color
  • Shortness of breath
  • Rapid heart rate
  • Yellow skin color (jaundice)
  • Dark urine
  • Enlarged spleen

Note: Severe hemolysis may cause hemoglobinuria (hemoglobin in the urine).

Signs and tests
  • Anemia
  • Hemolysis
  • Reduced G-6-PD activity
  • Reticulocytosis following a hemolytic crisis

Tests include:
  • Elevated bilirubin levels
  • Elevated serum LDH
  • Low serum haptoglobin
  • Hemoglobin in the urine
  • Elevated absolute reticulocyte count
  • Low red blood cell count and hemoglobin
  • Heinz bodies present on examination of the peripheral blood smear using special stains
  • Methylene blue test
  • Methemoglobin reduction test




CAUSES & RISK FACTORS

G-6-PD deficiency is an inheritable x-linked recessive disorder whose primary effect is the reduction of G-6-PD in the red blood cell, with resultant hemolysis of the cell. The ultimate effect of the disease is to produce anemia, either acute hemolytic or a chronic spherocytic type.

In the United States, the incidence of G-6-PD is much higher among the Black American population with a heterozygote frequency (carrier state with one normal gene and one abnormal gene) of 24%. Approximately 10 to 14% of the black American male population is affected. The disorder may occasionally affect a few black females to a mild degree (depending on their genetic inheritance). People with the disorder are not normally anemic and display no evidence of the disease until the red cells are exposed to an oxidant or stress.

Drugs that can precipitate this reaction include:
  • Antimalarial agents
  • Sulfonamides (antibiotic)
  • Aspirin
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Nitrofurantoin
  • Quinidine
  • Quinine
  • Others

Also:
  • exposure to certain chemicals such as those in mothballs.

The chronic spherocytic anemia is unaffected by exposure to these drugs.

The risk of acute hemolytic crisis can be decreased by reviewing the family history for any evidence of hemolytic anemia or spherocytosis or testing before giving any medications belonging to the above class of chemicals.

The episodes are usually brief, because newly produced (young) red cells have normal G6PD activity.

Risk factors are being of the black race, being male, or having a family history of G6PD deficiency. Another type of this disorder can occur in whites who originated in the Mediterranean basin. It, too, is associated with acute episodes of hemolysis. Episodes are longer and more severe than the other type of disorders.





PREVENTION

  • People with G-6-PD must strictly avoid factors that can precipitate an episode, especially drugs known to cause oxidative reactions.


  • Genetic counseling or genetic information may be of interest to heterozygous women and affected men.





  • EXPECTED OUTCOME

    Spontaneous recovery from hemolytic crises is the usual outcome.


    POSSIBLE COMPLICATIONS

    Rarely, kidney failure or death may occur following a severe hemolytic event.



    GENERAL MEASURES


    TREATMENT

    If the cause is an infection, it should be treated. If the cause is a drug, the offending agent should be stopped. People with the Mediterranean form, or those in hemolytic crisis may occasionally require transfusions.



    NOTIFY YOUR MIDWIFE OR HEALTH CARE PRACTITIONER IF...


    Call for an appointment with your health care provider if symptoms of hemolytic anemia due to G-6-PD deficiency develop.

    Call your health care provider if you have G-6-PD deficiency and symptoms of hemolytic anemia do not disappear after treatment of the cause.





    NUTRITIONAL THERAPY RECOMMENDATIONS FOR ANEMIA

    These nutritional recommendations are for general anemia, such as folic acid or iron deficiency anemia. Consult with your health care provider or nutritionist to see if any of these suggestions will help with anemia caused by G-6-PD deficiency.

    Nutrients
    Supplement Suggested Dosage Comments
    Essential
    Raw liver extract 500 mg twice daily. Contains all the elements needed for red blood cell production. Use liver from organically raised beef. Consider injections (under a health care provider's supervision).
    Blackstrap molasses Adults: 1 tablespoon twice daily.
    Children: 1 teaspoon twice daily.
    See above under Holistic Recommendations.
    Folic acid 800 mcg twice daily. Needed for red blood cell formation.
    Biotin 300 mcg daily. Needed for red blood cell formation.
    Iron As prescribed by a health care provider. Take with 100 mg vitamin C for better absorption. To restore iron. Use ferrous gluconate form. Caution: Do not take iron unless anemia is diagnosed.
    Floradix Iron Plus Herbs from Salus Haus 2 teaspoons daily. Contains a readily absorbable form of iron that is nontoxic and from a natural source.
    Vitamin B12 injections 2 cc once weekly or as prescribed by health care provider. Essential in red blood cell production and to break down and prepare protein for cellular use. Injections (under health care providers supervision) are best. If injections are not available, use lozenge or sublingual form for best absorption.
    Or vitamin B12 2,000 mcg 3 times daily Essential in red blood cell production and to break down and prepare protein for cellular use. Injections (under health care providers supervision) are best. If injections are not available, use lozenge or sublingual form for best absorption.
    Vitamin B complex 50 mg 3 times daily. B vitamins work best when taken together. A sublingual form is recommended.
    Pantothenic acid (vitamin B5 50 mg 3 times daily. Important in red blood cell production.
    Vitamin B6 (pyridoxine) 100 mg daily. Involved in cellular reproduction. Aids absorption of vitamin B 12.
    Vitamin C 3,000-10,000 mg daily. Important in iron absorption.
    Brewer's yeast As directed on label. Rich in basic nutrients and a good source of B vitamins.
    Copper 2 mg daily. Needed in red blood cell production. Note: If more zinc is used, increase copper proportionately.
    Zinc 30 mg daily. Do not exceed this amount. Needed to balance with copper.
    Raw spleen glandular As directed on label. See Glandular Therapy for more information.
    Vitamin A 10,000 IU daily. Important antioxidant.
    Plus natural beta-carotene 15,000 IU daily. Important antioxidant.
    Or carotenoid complex (Betatene) As directed on label. Important antioxidant.
    Vitamin E 600 IU daily. Take separately from iron supplements. Important for red blood cell survival; prolongs the life span of these cells. Use emulsion form for better assimulation.


    ANEMIA SUPPLEMENTS & PRODUCTS

    Information for help with anemia, a condition that occurs when either the number of red blood cells or the amount of hemoglobin in the blood is reduced.

    Iron Ionic Mineral Supplement, Fully Absorbable, 20 +/- ppm - 16 fl. oz.

    WaterOz Ionic Iron is a pure liquid Iron supplement. Iron is called the "energy giver." It attracts oxygen and builds blood. Along with manganese and copper it is necessary for healthy blood chemistry and is essential for recovery from illness.
    Appetite Stimulant Formula Tincture, 100% Organic - 2 fl. oz.

    This herbal appetite stimulant has been designed by a Master Herbalist to stimulate the appetite. It combines herbs well known, and recommended by the German Commission E, for improving the appetite and eliminating symptoms of appetite loss.
    Iron Complex w/ Vitamins & Herbs, Vegetarian Formula, NOW Foods - 250 Tabs

    Iron is part of myoglobin, which helps muscle cells store oxygen - iron-deficient people tire easily in part because their bodies are starved for oxygen and without enough iron, ATP (the fuel the body runs on) cannot be properly synthesized so, as a result, some iron-deficient people become fatigued even when their hemoglobin levels are normal.
    St. John's Wort, Perika, 300mg - 60 Tabs

    Nature's Way St. John's Wort is scientifically advanced to maintain a healthy emotional outlook.
    Folic Acid (Vitamin B-9) 100% Natural, Nature's Way 800mcg - 100 Caps

    Folic acid (Vitamin B-9) is necessary precursor for the manufacture of genetic material like RNA and DNA. It also assists in the growth and repair of tissues and in the conversion of fats and amino acids into other useful products in the body.
    Brewers Yeast, NOW Foods 650mg - 200 Tabs

    Brewer's Yeast has been shown to help people having difficulty sleeping, fatigued, and diarrhea caused by Clostridium difficile.
    Alfalfa Leaves, Nature's Way, 405mg - 100 Caps

    Nature's Way Alfalfa Leaves are organically grown by Trout Lake Farm, Washington, and Certified Organically Processed in accordance with Oregon Tilth standards and the California Organic Foods Act of 1990.
    Bilberry Extract Tincture, 100% Organic - 2 fl. oz.

    Helpful with many different diseases of the eyes including vascular retinal disturbances, cataracts, diabetic-induced glaucoma, myopia, and all forms of eye strain.
    Black Cherry Fruit Extract 750mg NOW Foods - 90 Vcaps

    Black Cherry extract or Black Cherry concentrate has been found to prevent attacks of gout. Black, sweet yellow, and red sour cherries have all shown to be effective.
    Dandelion Root Tincture, 100% Organic - 2 fl. oz.

    Dandelion root is a natural diuretic and improves appetite and minor digestive problems. Dandelion leaves are commonly recommended as a food supplement for pregnant and postmenopausal women.
    Goldenseal Root Tincture (Hydrastis canadensis), 100% Organic - 2 fl. oz.

    Uses include Adrenal Glands; Eye Problems; Fainting; Gallbladder; Gallstones; Nephritis; Pancreatic Disorders; Peritonitis; Poison Ivy/Oak; Prostate Problems; Psoriasis; Pyorrhea; Quinsy,;Scarlet Fever; Spinal Meningitis (sometimes referred to simply as Meningitis); Spleen; Wounds
    Pau D Arco (Purple Lapacho), Inner Bark 545mg - 180 Caps

    Pau d'arco is a South American herb which helps strengthen and nourish the body's defense system. A healthy immune system is a key in fighting diseases and infections.
    Red Raspberry Leaves, 480mg - 100 Caps

    Red raspberry leaf strengthens the uterus wall and regulates menstrual flow. It nourishes the reproductive organs, especially the uterine muscles, and helps strengthen and prepare the body for childbirth. It is also highly valued for its soothing and astringent properties to the stomach and intestinal tract.
    Maca (Lepidum meyenii) Tincture, 100% Organic - 2 fl. oz.

    Today Maca is used to increase energy and support the immune system. Maca can help a number of conditions from fatigue to frigidity.
    Instant Energy B-12 (2,000 mcg of B-12 per packet), NOW Foods - 75 Packets

    NOW® Vitamin B-12 Instant Energy is the perfect way to keep alert and energized, regardless of the situation. These convenient, fast-acting packets are perfect when traveling or for convenience.
    Vitamin C 1000 with Bioflavonoids, Nature's Way, 100% Natural, 1000mg - 250 Vcaps

    Nature's Way Vitamin C with Bioflavonoids provides antioxidant protection for many of the body's important enzyme systems.
    Meta C Vitamin C Supplement, 1000mg - 100 Tabs

    Meta C Vitamin C Supplement is a unique form of vitamin C that is absorbed faster than regular vitamin C and maintains higher serum levels for longer period of time with no intestinal discomfort.
    Vitamin C Liquid, with Rose Hips and Bioflavonoids, Kosher, Natural Citrus Flavor, 1000mg - 16 fl. oz.

    Liquid Vitamin C with Natural Rose Hips & Bioflavonoids is an easy to swallow dietary supplement that exceeds the recommended daily intake of vitamin C.
    Nettle Tincture, 100% Organic - 2 fl. oz.

    Nettle leaf has become a popular treatment of allergies (hay fever) and it can improve goiter, inflammatory conditions, and arthritis.
    Amalaki (Dhatri), 100% Natural, 450mg - 120 VCaps

    Amalaki is an Ayurvedic effective against allergies, anemia, cold & flu, constipation, diabetes, digestive disorders, and liver problems.
    Copper Ionic Mineral Supplement, Fully Absorbable, 50 +/- ppm - 16 fl. oz.

    WaterOz Ionic Copper is a pure liquid Copper supplement. Copper influences protein metabolism and general healing, improves vitamin C oxidation and is integral in the formation of RNA.
    Vitamin B-12 (Cobalamin), 50mcg & B-9 (Folic Acid), 400mcg - 1 fl. oz.

    Vitamin B-12 (Cobalamin) helps to maintain a healthy nervous system and helps in the prevention of pernicious anemia.
    Heart Formula Tincture, 100% Organic - 2 fl. oz.

    The Heart Formula can be used for anemia, fatigue and heart problems.
    Spleen & Pancreas Formula Tincture, 100% Organic - 2 fl. oz.

    Use the Spleen & Pancreas Formula to strengthen and nourish the spleen and pancreas naturally.
    Dong Quai Root Tincture, 100% Organic - 2 fl. oz.

    Dong Quai root is often used in the treatment of menstrual cramps, or dysmenorrhea and PMS, hot flashes, and other menopausal symptoms.
    Once Daily Multi Vitamin & Mineral, All Natural, Lactose Free, w/ Iron - 100 Tabs

    Nature's Way Daily Multi Vitamin & Mineral provides many of the essential nutrients that modern diets may lack. They are useful for protection, growth and maintenance of body systems as they age.
    Alive! Whole Food Energizer Multi Vitamin with Mineral, Nature's Way 18mg of Iron added - 90 Tabs

    Alive Whole Food Energizer Multi Vitamin with Mineral with Iron by Nature's Way is absorbed into your blood stream 5 times faster than other leading brands.
    Ester C with Bioflavonoids, 25% More Free, 500mg / 200mg - 150 Vcaps

    Nature's Way Ester C with bioflavonoids is 100% natural calcium ascorbate with biologically active metabolites. These metabolites enhance cellular uptake and retention of Vitamin C. Now get 25% more free.
    Vitamin C Liquid, with Rose Hips and Bioflavonoids, Kosher, Natural Citrus Flavor, 1000mg - 16 fl. oz.

    Liquid Vitamin C with Natural Rose Hips & Bioflavonoids is an easy to swallow dietary supplement that exceeds the recommended daily intake of vitamin C.
    Barberry Tincture, 100% Organic - 2 fl. oz.

    Barberry is used for treating gallbladder disease, heartburn and indigestion and diarrhea. This herb can also be used to treat infections, parasites, psoriasis, and vaginitis.
    Cocoa Powder - Certified Organic 100% Natural

    From holiday desserts and everyday baking, to a steaming cup of hot cocoa on those cold winter days, NOW® Organic Cocoa Powder offers a guilt-free way to satisfy your sweet tooth without the high amounts of sugar, fat and preservatives common to many commercially available mixes.





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    MOONDRAGON'S ANEMIA LINKS

    MoonDragon's Obgyn-Health Anemia Index

    Anemia, Folic Acid Deficiency

    Anemia, Iron Deficiency

    Anemia, Pernicious

    MoonDragon's Practice Guidelines for Anemia

    Anemia During Pregnancy

    Anemia, Sickle Cell

    Anemia, Thalassemia




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