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Vitamin C induced hemolysis: Meta summary and review of literature
  • Ravi Jain,
  • Deven Juneja,
  • Prashant Nasa
Ravi Jain
Mahatma Gandhi Medical College and Hospital

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Deven Juneja
Max Super Speciality Hospital Saket
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Prashant Nasa
NMC specialty Hospital, Dubai, United Arab Emirates
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Background: Vitamin C is increasingly being used for treating myriad clinical conditions. Even high doses of vitamin C are considered safe, but complications including hemolysis have been reported. Methods: We performed a systematic search, from PubMed, Science Direct, and Google Scholar databases, from January 1975 till 31st July 2021. The search terms used were “Vitamin C” OR “ascorbic acid” AND “hemolysis” OR “hemolytic anemia” and data regarding patient’s demographics, dose, duration, and form of vitamin C therapy and the patient outcomes were extracted. Results: A total of 14 case reports matched the selected criteria. The age of the patients ranged from 3 weeks to 75 years with 78.6% being males. 71.4% were diagnosed to have Glucose-6-phosphate dehydrogenase (G6PD) deficiency but the previous history of hemolysis was reported in only two patients. 57.1% were prescribed vitamin C for nutritional supplementation. The dose ranged from 1 to 200 gm/day with 57.1% receiving intravenous formulations. Half of these patients also developed other complications including acute kidney injury (AKI), disseminated intravascular coagulation, oxalosis and methemoglobinemia. A great majority (78.6%) developed complications within 3 days of starting vitamin C and only 1 death (7%) was reported. Conclusions: Vitamin C is generally a safe drug but like any other drug it should be prescribed with caution and only when clinically indicated. Physicians should be aware of potential complications like severe hemolysis and AKI which may be precipitated when using high dose vitamin C, especially in a patient with G6PD deficiency.