Advancements in the Study of G6PD Deficiency in Transfusion Medicine

doi:10.3969/j.issn.1671-2587.2025.02.017

JOURNAL OF CLINICAL TRANSFUSION AND LABORATORY MEDICINE ›› 2025, Vol. 27 ›› Issue (2): 261-266.DOI: 10.3969/j.issn.1671-2587.2025.02.017

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Advancements in the Study of G6PD Deficiency in Transfusion Medicine

QING Yun, HUANG Xia

Chongqing Blood Center, Chongqing 400052

Received:2024-12-06 Online:2025-04-20 Published:2025-04-17

Abstract

Abstract: Deficiency of glucose-6-phosphate dehydrogenase (G6PD) can lead to the destruction of red blood cells during oxidative stress responses. Although screening for G6PD deficiency is not currently a routine practice in healthy blood donors, there are reports in the literature that transfusion of RBCs from individuals with G6PD deficiency can lead to hemolysis and other adverse events. Moreover, certain patient populations may be more susceptible to complications associated with the transfusion of G6PD-deficient RBCs. This article reviews the pathogenesis of G6PD deficiency and its clinical challenges in transfusion practice, aiming to improve the effectiveness and safety of blood transfusion for relevant populations.

Key words: G6PD deficiency, Blood donors, Transfusion, Hemolysis

CLC Number:

R457.1R556.6

QING Yun, HUANG Xia. Advancements in the Study of G6PD Deficiency in Transfusion Medicine[J]. JOURNAL OF CLINICAL TRANSFUSION AND LABORATORY MEDICINE, 2025, 27(2): 261-266.

References

[1] NKHOMA E T,POOLE C,VANNAPPAGARI V, et al.The global prevalence of glucose-6-phosphate dehydrogenase deficiency:a systematic review and meta-analysis[J]. Blood Cells Mol Dis,2009,42(3):267-278.
[2] GLYNN S A,KLEIN H G,NESS P M.The red blood cell storage lesion:the end of the beginning[J]. Transfusion,2016,56(6):1462-1468.
[3] SPITALNIK S L,TRIULZI D,DEVINE D V,et al.2015 proceedings of the national heart,lung,and blood institute's state of the science in transfusion medicine symposium[J]. Transfusion,2015,55(9):2282-2290.
[4] YEE M E,FRANCIS R O,LUBAN N L C,et al. Glucose-6-phosphate dehydrogenase deficiency is more prevalent in Duffy-null red blood cell transfusion in sickle cell disease[J]. Transfusion,2022,62(3):551-555.
[5] YEE M E M,FASANO R M. Novel approaches to measure transfusion effectiveness[J]. Curr Opin Hematol,2023,30(6):230-236.
[6] ROJPHOUNG P,RUNGROUNG T,SIRIBOONRIT U,et al.Prevalence of G6PD deficiency in Thai blood donors,the characteristics of G6PD deficient blood,and the efficacy of fluorescent spot test to screen for G6PD deficiency in a hospital blood bank setting[J]. Hematology, 2022,27(1):208-213.
[7] KARAFIN M S,FRANCIS R O.Impact of G6PD status on red cell storage and transfusion outcomes[J]. Blood Transfus,2019,17(4):289-295.
[8] LUZZATTO L,NANNELLI C,NOTARO R.Glucose-6-phosphate dehydrogenase deficiency[J]. Hematol Oncol Clin North Am,2016,30(2):373-393.
[9] ZHENG Y Z,WANG J L,LIANG X Y,et al.Epidemiology,evolutionary origin,and malaria-induced positive selection effects of G6PD-deficient alleles in Chinese populations[J]. Mol Genet Genomic Med, 2020,8(12):e1540.
[10] ZHONG K,WANG W,HE F L,et al.The status of neonatal screening in China,2013[J]. J Med Screen,2016, 23(2):59-61.
[11] FERREIRA N S,ANSELMO F C,ALBUQUERQUE S R L,et al. G6PD deficiency in blood donors of Manaus,Amazon Region,northern Brazil[J]. Int J Lab Hematol,2021,43(6):e290-e293.
[12] KITTISARES K,PALASUWAN D,NOULSRI E,et al.Thalassemia trait and G6PD deficiency in Thai blood donors[J]. Transfus Apher Sci,2019,58(2):201-206.
[13] EMAMGHORASHI F,HOSHMAND F, MOHTASHAMIFAR A.Screening for glucose-6-phosphate dehydrogenase deficiency in blood donors[J]. Hematology,2010,15(2):122-124.
[14] LIANG H F,LIN F,LU J,et al.Glucose-6-phosphate dehydrogenase deficiency screening and gene analysis in blood donors of Guangdong province[J]. Hematology, 2022,27(1):494-498.
[15] JIN J H,JIANG J,XU Y S,et al.Screening,genotyping and haematological analysis of glucose-6-phosphate dehydrogenase deficiency in the blood donors of Wuxi City,China[J]. Vox Sang,2024,119(10):1039-1046.
[16] LUZZATTO L,ARESE P.Favism and glucose-6-phosphate dehydrogenase deficiency[J]. N Engl J Med,2018,378(11):1068-1069.
[17] ALGUR N,AVRAHAM I,HAMMERMAN C,et al.Quantitative neonatal glucose-6-phosphate dehydrogenase screening:distribution,reference values,and classification by phenotype[J]. J Pediatr,2012,161(2):197-200.
[18] WANG J,XIAO Q Z,CHEN Y M,et al.DNA hypermethylation and X chromosome inactivation are major determinants of phenotypic variation in women heterozygous for G6PD mutations[J]. Blood Cells Mol Dis,2014,53(4):241-245.
[19] TOWN M,BAUTISTA J M,MASON P J,et al.Both mutations in G6PD A-are necessary to produce the G6PD deficient phenotype[J]. Hum Mol Genet, 1992, 1(3):171-174.
[20] WANG L,ROCHON E R,GINGRAS S,et al.Functional effects of an African glucose-6-phosphate dehydrogenase (G6PD) polymorphism (Val68Met) on red blood cell hemolytic propensity and post-transfusion recovery[J]. Transfusion,2024,64(4):615-626.
[21] PAGE G P,KANIAS T,GUO Y J,et al.Multiple-ancestry genome-wide association study identifies 27 loci associated with measures of hemolysis following blood storage[J]. J Clin Invest,2021,131(13):e146077.
[22] ROUBINIAN N H,REESE S E,QIAO H,et al.Donor genetic and nongenetic factors affecting red blood cell transfusion effectiveness[J]. JCI Insight, 2022,7(1):e152598.
[23] FRANCIS R O,JHANG J,HENDRICKSON J E,et al.Frequency of glucose-6-phosphate dehydrogenase-deficient red blood cell units in a metropolitan transfusion service[J]. Transfusion,2013,53(3):606-611.
[24] MENY G M.An update on the Duffy blood group system[J]. Immunohematology,2019,35(1):11-12.
[25] DANKWA S,CHAAND M,KANJEE U,et al.Genetic evidence for erythrocyte receptor glycophorin B expression levels defining a dominant Plasmodium falciparum invasion pathway into human erythrocytes[J]. Infect Immun,2017,85(10):e00074-17.
[26] ALHIWAISHIL H M,ALGHAREEB M A,ALKHARS A S,et al.Rate of glucose-6-phosphate dehydrogenase deficiency in neonatal indirect hyperbilirubinemia at a private tertiary centre[J]. Saudi Med J, 2024, 45(10):1057-1063.
[27] ANASTASIADI A T,STAMOULIS K,KRIEBARDIS A G,et al.Molecular modifications to mitigate oxidative stress and improve red blood cell storability[J]. Front Physiol,2024,15:1499308.
[28] ORLINA A R,JOSEPHSON A M,MCDONALD B J.The poststorage viability of glucose-6-phosphate dehydrogenase-deficient erythrocytes[J]. J Lab Clin Med,1970,75(6):930-936.
[29] TZOUNAKAS V L,KRIEBARDIS A G, GEORGATZAKOU H T,et al.Data on how several physiological parameters of stored red blood cells are similar in glucose 6-phosphate dehydrogenase deficient and sufficient donors[J]. Data Brief,2016,8:618-627.
[30] KRIEBARDIS A G,ANTONELOU M H,STAMOULIS K E,et al.Progressive oxidation of cytoskeletal proteins and accumulation of denatured hemoglobin in stored red cells[J]. J Cell Mol Med,2007,11(1):148-155.
[31] ORLINA A R,JOSEPHSON A M,MCDONALD B J.The poststorage viability of glucose-6-phosphate dehydrogenase-deficient erythrocytes[J]. J Lab Clin Med,1970,75(6):930-936.
[32] LACHANT N A,NOBLE N A,MYRHE B A,et al.Antioxidant metabolism during blood storage and its relationship to posttransfusion red cell survival[J]. Am J Hematol,1984,17(3):237-249.
[33] TANG H Y,HO H Y,WU P R,et al.Inability to maintain GSH pool in G6PD-deficient red cells causes futile AMPK activation and irreversible metabolic disturbance[J]. Antioxid Redox Signal, 2015,22(9):744-759.
[34] SCHINDLER S M,LITTLE J P,KLEGERIS A.Microparticles:a new perspective in central nervous system disorders[J]. Biomed Res Int,2014,2014:756327.
[35] ROTHER N,YANGINLAR C,PIETERSE E,et al.Microparticles in autoimmunity:cause or consequence of disease?[J]. Front Immunol,2022,13:822995.
[36] AUNG H H,TUNG J P,DEAN M M,et al.Procoagulant role of microparticles in routine storage of packed red blood cells:potential risk for prothrombotic post-transfusion complications[J]. Pathology,2017,49(1):62-69.
[37] FISCHER D,BÜSSOW J,MEYBOHM P,et al. Microparticles from stored red blood cells enhance procoagulant and proinflammatory activity[J]. Transfusion,2017,57(11):2701-2711.
[38] NOULSRI E,LERDWANA S,PALASUWAN D,et al.Cell-derived microparticles in blood products from blood donors deficient in glucose-6-phosphate dehydrogenase[J]. Lab Med,2021,52(6):528-535.
[39] LIVNEH I,COHEN-KAPLAN V,COHEN-ROSENZWEIG C,et al.The life cycle of the 26S proteasome:from birth,through regulation and function,and onto its death[J]. Cell Res,2016,26(8):869-885.
[40] TZOUNAKAS V L,DZIECIATKOWSKA M,ANASTASIADI A T,et al.Red cell proteasome modulation by storage,redox metabolism and transfusion[J]. Blood Transfus,2022,20(1):27-39.
[41] KANIAS T,LANTERI M C,PAGE G P,et al.Ethnicity,sex,and age are determinants of red blood cell storage and stress hemolysis:results of the REDS-Ⅲ RBC-Omics study[J]. Blood Adv,2017,1(15):1132-1141.
[42] TZOUNAKAS V L,KRIEBARDIS A G,GEORGATZAKOU H T,et al.Glucose 6-phosphate dehydrogenase deficient subjects may be better “storers” than donors of red blood cells[J]. Free Radic Biol Med,2016,96:152-165.
[43] REISZ J A,TZOUNAKAS V L,NEMKOV T,et al.Metabolic linkage and correlations to storage capacity in erythrocytes from glucose 6-phosphate dehydrogenase-deficient donors[J]. Front Med (Lausanne),2018,4:248.
[44] RICE-EVANS C,RUSH J,OMORPHOS S C,et al.Erythrocyte membrane abnormalities in glucose-6-phosphate dehydrogenase deficiency of the Mediterranean and A-types[J]. FEBS Lett, 1981,136(1):148-152.
[45] MIMOUNI F,SHOHAT S,REISNER S H.G6PD-deficient donor blood as a cause of hemolysis in two preterm infants[J]. Isr J Med Sci,1986,22(2):120-122.
[46] UYOGA S,MACHARIA A W,NDILA C M,et al.Glucose-6-phosphate dehydrogenase deficiency and susceptibility to childhood diseases in Kilifi,Kenya[J]. Blood Adv, 2020,4(23):5942-5950.
[47] KELLER C C,JOOSTEN M,MIDDELDORP A M,et al.Fetal Anemia caused by the Guadalajara variant of G6PD deficiency[J]. Prenat Diagn,2015,35(12):1255-1257.
[48] SAGIV E,FASANO R M,LUBAN N L C,et al. Glucose-6-phosphate-dehydrogenase deficient red blood cell units are associated with decreased posttransfusion red blood cell survival in children with sickle cell disease[J]. Am J Hematol,2018,93(5):630-634.
[49] BANKS M,SHIKLE J.Hyperhemolysis syndrome in patients with sickle cell disease[J]. Arch Pathol Lab Med,2018,142(11):1425-1427.
[50] SHALEV O,MANNY N,SHARON R.Posttransfusional hemolysis in recipients of glucose-6-phosphate dehydrogenase-deficient erythrocytes[J]. Vox Sang, 1993,64(2):94-98.
[51] World Health Organization. Blood Donor Selection: Guidelines on Assessing Donor Suitability for Blood Donation [EB/OL].(2012-01-01). https://www.who.int/.

Advancements in the Study of G6PD Deficiency in Transfusion Medicine

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