Author/Authors :
Jafari Majid نويسنده Management Group, Kish International Unit, Islamic Azad University, Kish, Iran , Abolfazl Afjeh Seyyed نويسنده Pediatric Infections Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran , Taslimi Taleghani Naeeme نويسنده Mahdieh Medical Center, Shahid Beheshti University of
Medical Sciences, Tehran, IR Iran
Abstract :
Introduction Methylene blue was first described for the treatment
of methemoglobinemia but practical usage of the compound for surgical
purpose is common. The aim of this report is to describe a case of
hemolysis in neonatal period as a potential hazard of methylene blue
toxicity without presence of G6PD deficiency. Case Presentation In
October 2015, a 36-week GA female infant with 2.05 kg weight was
delivered by cesarean section with APGAR score of 9/9 from a healthy
mother, with common type esophageal atresia. She underwent surgical
repair with drainage tube placement on second day of life in our
subspecialty referral center, Tehran, Iran. Her blood group type was A+
and her mother was AB+ with no family history of hematologic disease. On
fifth day postoperative, 2 mL of methylene blue solution that was
prepared by dissolving its powder in the hospital laboratory were fed
per oral for confirmation of the integrity of esophagus after repair. 8
days after methylene blue ingestion, we met suddenly the occurrence of
severe anemia and hyperbilirubinemia with Hb: 6 gr/dL (post-operative
Hb: 15 gr/dL) , retic count: 4.8%, total bill/direct: 20/ 0.3, indirect
coombs negative ,G6PD: sufficient, ALT: 30 U/L, and AST: 66U/L. At
follow-up 2 months after the initial operation, barium meal showed
moderate stricture at the site of anastomosis. Conclusions We considered
two main reasons for hemolysis in our patient. The first explanation is
that our patient received 20 mg/kg MB as solution which was nearly 5 -
10 times more concentrated than the recommended dose. The second is that
the absorption of MB from mediastinal/plural space could be more than
expected. Our justification for this event is the anastomosis site
stricture at follow-up that was suggestive of Methylene blue leak to
mediastinal/plural space on first day after repair. Therefore, paying
attention to the preparation of methylene blue solution from its powder
is essential. Determination of G6PD status as a risk factor for
development of methylene blue toxicity is recommended. However, G6PD
with two rechecks was sufficient for our patient.
