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RASBURICASE INDUCED METHEMOGLOBINEMIA: A SYSTEMATIC REVIEW OF DESCRIPTIVE STUDIES

Abstract Purpose: There are an increased number of reports being
published on rasburicase-induced methemoglobinemia recently. We aimed to
identify and critically evaluate all the descriptive studies that
described the rasburicase-induced methemoglobinemia, its treatment
approach, and their outcomes. Methodology: PubMed and grey literature
databases were searched from inception to January 2021 using search
terms “rasburicase” and “methemoglobinemia” without any language and
date restriction. A bibliographic search was also done to find
additional studies. Only descriptive studies on Rasburicase-induced
methemoglobinemia were included for our review. Two contributors worked
independently on study selection, data abstraction, and quality
assessment, and any disagreements were resolved by consensus or
discussion with a third reviewer. Result: A total of 22 reports
including 25 patients (21 male, 3 female patients, and 1 study did not
specify the gender of the patient) aged from 6 to 75 years were included
in the review. Immediate withdrawal of the drug and administering
methylene blue, ascorbic acid, blood transfusion, and supportive oxygen
therapy are the cornerstone in the management of rasburicase-induced
methemoglobinemia. Conclusion: Rasburicase administration should be
followed by careful monitoring of patients for any severe complication
and treat it as early as possible appropriately. In a patient who
presents with rasburicase-induced haemolysis or methemoglobinemia, it is
often important to expect a diagnosis of G6PD deficiency unless
otherwise confirmed and to avoid administering methylene blue, even
though the patient is from a low-risk ethnicity for G6PDD. PROSPERO
Registration number: CRD42021234132