Glucose 6-Phosphate Dehydrogenase (G6PD), Quantitative, Blood and Hemoglobin

CPT: 82955; 85018
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Test Details

Synonyms

  • G6PD, Quantitative, Blood and Hgb
  • G6PDH

Use

Evaluate glucose 6-phosphate dehydrogenase (G6PD) deficiency. G6PD deficiency, an X-linked disorder, is the most common enzymatic disorder of red blood cells in humans, affecting more than 400 million people worldwide. The clinical expression of G6PD variants encompasses a spectrum of hemolytic syndromes. Affected patients are most often asymptomatic, but many patients have episodic anemia, while a few have chronic hemolysis.

With the most prevalent G6PD variants (G6PD A- and G6PD Mediterranean), hemolysis is induced in children and adults by the sudden destruction of older, more deficient erythrocytes after exposure to drugs having a high redox potential (including the antimalarial drug primaquine and certain sulfa drugs) or to fava beans, selected infections, or metabolic abnormalities. In the neonate with G6PD deficiency, however, decreased bilirubin elimination may play an important role in the development of jaundice.

G6PD deficiency should be suspected in any subject with an episode of nonimmune hemolytic anemia, especially if occurring after drug ingestion, infection, or an episode of diabetic ketoacidosis.

Limitations

False normal results after hemolysis may occur. See Additional Information.

Levels of G6PD are higher in the newborn than they are in the adult.

When high levels are seen in older patients, it invariably reflects the presence of a young red blood cell population with reticulocytosis.

Methodology

Kinetic − 340 nm

Reference Interval

4.6−13.5 units/g hemoglobin

Additional Information

G6PD hemolysis is associated with formation of Heinz bodies in peripheral red blood cells. It is the older erythrocytes that are most G6PD-deficient in affected individuals. These cells are first eliminated in a hemolytic crisis. The younger cells and reticulocytes contain more G6PD. For these reasons, after a hemolytic crisis, when only younger erythrocytes and reticulocytes are present, the G6PD values may be spuriously normal.

These "false-negative" (ie, spuriously normal or high) results are a potential concern because the most severely deficient red cells have already been removed from the circulation via hemolysis.

This problem is usually not important when testing male Caucasians but is a concern in some Caucasian females and blacks of both sexes, especially during the reticulocytosis following acute hemolysis. When a false-negative test is suspected, the best approach is to reëvaluate the patient three months after the hemolytic episode, a time at which the red cell mass will have been repopulated with red cells of all ages.

To prevent future hemolytic episodes, subjects with G6PD deficiency should avoid drugs and chemicals with oxidant potential. A partial list of safe and unsafe drugs is given in the following table.

Partial List of Drugs and Chemicals in Glucose-6-Phosphate Dehydrogenase Deficiency*

Unsafe for Class I, II, and III Variants

Safe for Class II and III Variants

*Note: This is a partial list only.

Source: Beutler E. G6PD deficiency. Blood. 1994 Dec 1; 84(11):3613-3636.

Acetanilid

Acetaminophen

Dapsone

Aminopyrine

Furazolidone

Ascorbic acid (except in very high doses)

Methylene blue

Aspirin

Nalidixic acid

Chloramphenicol

Naphthalene (mothballs, henna)

Chloroquine

Niridazole

Colchicine

Nitrofurantoin

Diphenhydramine

Phenazopyridine

Isoniazid

Phenylhydrazine

L-Dopa

Primaquine

Menadione

Sulfacetamide

Para-aminobenzoic acid

Sulfamethoxazole (Δ)

Phenacetin

Sulfanilamide

Phenytoin

Sulfapyridine

Probenecid

Thiazolesulfone

Procainamide

Toluidine blue

Pyrimethamine

Trinitrotoluene

Quinidine

Uricase (rasburicase, pegloticase)

Quinine

Streptomycin

Sulfamethoxypyridazine

Sulfisoxazole

Trimethoprim

Tripelennamine

Vitamin K

Specimen Requirements

Specimen

Whole blood

Volume

8 mL (4 mL in each of two tubes)

Minimum Volume

Hemoglobin: two 500-μL lavender-top Microtainer™ tubes filled to at least 50% of tube capacity (Note: If any other size lavender tube is used, the tube must be filled to at least 50% capacity of tube fill volume. Insufficient volume may limit the extent of procedures performed.); and G6PD: one lavender-top (EDTA) tube, green-top (heparin) tube, or yellow-top (ACD) tube (0.1 mL) whole blood.

Container

Two lavender-top (EDTA) tubes or one green-top (heparin) tube and one lavender-top (EDTA) tube or one yellow-top (ACD) tube and one lavender-top (EDTA) tube

Storage Instructions

Hemoglobin: Stable refrigerated for 72 hours. G6PD: Stable refrigerated for seven days.

Causes for Rejection

Hemoglobin: Hemolysis; tube not filled with minimum fill volume; specimen drawn in any anticoagulant other than EDTA; specimens diluted or contaminated with IV fluid; clotted specimen; improper labeling; transfer tubes with whole blood; lavender-top (EDTA) tubes received with plasma removed; samples more than 72 hours old. G6PD: Frozen specimen.

LOINC® Map

Order Code Order Code Name Order Loinc Result Code Result Code Name UofM Result LOINC
121003 G-6-PD, Quant, Blood and Hgb 005041 Hemoglobin g/dL 718-7
121003 G-6-PD, Quant, Blood and Hgb 121008 G-6-PD, Quant U/g Hb 32546-4
Reflex Table for G-6-PD, Quant
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 001929 Comment: 001929 Comment: N/A

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