(Primaquine): (878-79- Harrison 18th edition; 1025-Davidson 21st)Drugs That Carry Risk of Clinical Hemolysis in Persons With G6PD Deficiency Definite RiskPossible RiskDoubtful RiskAntimalarialPrimaquineDapsone/chlorproguanilChloroquineQuinineSulphonamides / sulphonesSulfamethoxazoleOthersDapsoneSulfasalazineSulfisoxazoleAntibacterial/ antibioticsCotrimoxazole Nalidixic acid Nitrofurantoin NiridazoleCiprofloxacinNorfloxacinChloramphenicol p-Aminosalicylic acidAntipyretic/ AnalgesicAcetanilidePhenazopyridineAcetylsalicylic acid high dose (>3g/d)Acetylsalicylic acid (<3 g/d)AcetaminophenPhenacetinOthersNaphthaleneMethylene blueVitamin K analogues Ascorbic acid > 1g RasburicaseDoxorubicinProbenecid Glucose-6-phosphate dehydrogenase deficiencyClinical features* Acute drug-induced haemolysis to (e.g)Analgesics:aspirin, phenacetinAntimalarials: primaquine, quinine, chloroqine, pyrimethamineAntibiotics: sulphonamides, nitrofuration, ciprofloxacinMiscellaneousrquinidine, probenecid, vitamin K, dapsoneChronic compensated haemolysisInfection or acute illnessNeonatal jaundice: may be a feature of the B enzymeFavism, i.e. acute haemolysis after ingestion of the broad been Vicia faba* Laboratory featuresNon spherocytic intravascular haemolysis during an attackThe blood film will show:Bite cells (red cells with surface blistering of the membrane)Blister cells (red cells with surface blistering of the membrane)Irregularly shaped small cellsPolychromasia reflecting the reticulocytosisDenatured haemoglobin visible as Heinz bodies within the red cell cytoplasm, if stained with a supravital stain such as methyl violetG6PD levelCan be indirectly assessed by screening methods which usually depend upon the decreased ability to reduce dyesDirect assessment of G6PD is made in those with low screening valuesCare must be taken close to an acute haemolyti episode because reticulocytes may have higher enzyme levels and give rise to a false normal result.