The Drug-Induced Respiratory Disease Website

Rasburicase

Methemoglobinemia

Known since the 1940s (PMID 18883450). Comprehensive list of causal drugs and chemicals available at PMID 1564446. Methemoglobin is the oxidized (Fe3+) species of hemoglobin (Fe2+). Patients present with slate-grey cyanosis, low SpO2, normal SaO2 and PaO2. Normally, methemoglobin is <1%. Levels above 40% can be life-threatening, producing pulmonary edema, cardiovascular collapse (PMID 17122537) CNS disturbances and death. Management includes i.v. methylene blue. A possible rebound increase in MeHb upon treatment requires close monitoring. Excess methylene blue can also produce methemoglobinemia. Guidelines: PMID 34467556.

Publications

Surya N, Wu CH, Ryan H

Rasburicase-induced methemoglobinemia and haemolytic anaemia in a patient with G6PD deficiency.

BMJ case reports 2025 Mar 31;18; — 2025 Mar 31

Madanat L, Schoenherr D, Wey E, Gupta R

Rasburicase-induced haemolysis and methemoglobinemia: an ongoing issue.

BMJ case reports 2021 Mar 16;14; — 2021 Mar 16

Marinacci LX, Simeone FJ, Lundquist AL, Kuter DJ, Mahowald GK

Case 38-2020: A 52-Year-Old Man with Cancer and Acute Hypoxemia.

The New England journal of medicine 2020 Dec 10;383;2372-2383 — 2020 Dec 10 — 2372-2383

Raru Y, Abouzid M, Parsons J, Zeid F

Rasburicase induced severe hemolysis and methemoglobinemia in a Caucasian patient complicated by acute renal failure and ARDS.

Respiratory medicine case reports 2019;26;142-145 — 2019 — 142-145

Ibrahim U, Saqib A, Mohammad F, Atallah JP, Odaimi M

Rasburicase-induced methemoglobinemia: The eyes do not see what the mind does not know.

Journal of oncology pharmacy practice : official publication of the International Society of Oncology Pharmacy Practitioners 2018 Jun;24;309-313 — 2018 Jun — 309-313

Bontant T, Le Garrec S, Avran D, Dauger S

Methaemoglobinaemia in a G6PD-deficient child treated with rasburicase.

BMJ case reports 2014 Aug 12;2014; — 2014 Aug 12

Bucklin MH, Groth CM

Mortality following rasburicase-induced methemoglobinemia.

The Annals of pharmacotherapy 2013 Oct;47;1353-8 — 2013 Oct — 1353-8

Bauters T, Mondelaers V, Robays H, De Wilde H, Benoit Y, De Moerloose B

Methemoglobinemia and hemolytic anemia after rasburicase administration in a child with leukemia.

International journal of clinical pharmacy 2011 Feb;33;58-60 — 2011 Feb — 58-60

Browning LA, Kruse JA

Hemolysis and methemoglobinemia secondary to rasburicase administration.

The Annals of pharmacotherapy 2005 Nov;39;1932-5 — 2005 Nov — 1932-5