Previously, the Emergency Department, Gia Dinh People's Hospital received patient L.T.D (born in 2011, residing in Binh Thanh ward, Ho Chi Minh City) in a state of high fever accompanied by dizziness, shortness of breath, purple lips and extremities, very low SpO2 index despite oxygen support.
Through examination and diagnostic imaging, it was shown that the patient's lungs were not damaged, suggesting that the hypoxia did not originate from a simple respiratory cause. The patient was consulted with multiple specialists and transferred to the Intensive Care - Poison Control Department.
The arterial blood gas results recorded an increase in Methemoglobin (MetHb) at a rate of 15 - 20%, while the normal value is below 1%. This is a state where hemoglobin is inactivated, no longer able to transport oxygen to tissues. Causes such as poisoning, inappropriate drug use or banned substances are all ruled out.
The patient tested positive for the Dengue virus, however, the clinical progression was not suitable for a common dengue fever case. During monitoring, doctors recorded that he had jaundice, dark urine, and progressive anemia. Before suspected acute hemolytic hemorrhage, the treatment team prescribed G6PD enzyme dosage, determining severe G6PD enzyme deficiency.
BS.CK1 Dao Thi Huyen, Department of Intensive Care - Poison Control, Gia Dinh People's Hospital, said that G6PD enzyme deficiency is a genetic disease related to X chromosomes, making red blood cells easily destroyed when the body encounters oxidizing agents such as infections, eating silkworm beans or using some types of drugs.
In this case, Dengue hemorrhagic fever is considered a triggering factor, leading to acute endovascular hemolysis, causing severe anemia, and at the same time increasing MetHb, causing the oxygen transport capacity of the blood to seriously decline. This is the reason why the cyanosis and low SpO2 did not improve even though the patient was exposed to high concentrations of oxygen.
Faced with critical developments, to save the patient, doctors focused on treatment with blood transfusion to replenish red blood cells, support respiration, ensure circulatory volume, closely monitor kidney function, support liver function and absolutely avoid drugs as well as risk factors that cause hemolytic hemorrhage.
After 6 days of treatment, the patient's condition improved significantly and he was discharged from the hospital in stable condition.
Dr. Huynh Quang Dai, head of the Department of Intensive Care - Poison Control, Gia Dinh People's Hospital, warned that Dengue hemorrhagic fever on a patient with congenital G6PD deficiency is a particularly dangerous clinical situation, easily overlooked if the medical history is not fully recorded. Early identification of hemolysis accompanied by secondary Methemoglobin and timely treatment play a decisive role in the patient's survival prognosis.
Children with symptoms of fever accompanied by jaundice, dark urine, and shortness of breath need to be hospitalized early. Children who already know about G6PD deficiency need to be closely monitored when suffering from infections or viruses, avoid eating silkworm beans and foods and medicines that are at risk of oxidation. Parents should conduct G6PD deficiency screening for children from birth and proactively notify medical staff when examining or hospitalizing.
