A comprehensive review on methemoglobinemia
Corresponding Author(s) : V.Srividhya
srividhyaveeramuthu1995@gmail.com
International Journal of Allied Medical Sciences and Clinical Research,
Vol. 9 No. 2 (2021): 2021 Volume - 9 Issue - 2
Abstract
Methemoglobinemia is a blood condition in which the production of methemoglobin (MetHb) is irregular and thus unable to adequately release oxygen to body tissues. This is largely because MetHb is the altered hemoglobin (Hb) state in which heme's ferrous iron has been oxidized to the ferric state. This review paper explores in depth the various forms of methemoglobinemia and the biochemical pathways and mechanisms of their causes. If they have cyanosis, patients with high MetHb in the blood can look blue, but the methylene blue solution will heal them. However, for strategic care, proper management should be identified. This analysis would be helpful in learning the basics of methemoglobinemia and its current treatment with recommendations for health care professionals, pharmacists, biochemists, and researchers. This study will allow readers to understand methemoglobinemia and will be a ready guide for it.
Keywords
Hemoglobin
Methemoglobinemia
Methylene blue
MetHb
1.
Dr.R.Manivannan, Dr. S.Kameshwaran, V.Srividhya, R.Praveen raj, R.Pravin. A comprehensive review on methemoglobinemia. Int. J. of Allied Med. Sci. and Clin. Res. [Internet]. 2021 Apr. 2 [cited 2025 Sep. 24];9(2):108-12. Available from: https://ijamscr.com/ijamscr/article/view/982
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References
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1. Kucera A, Smith B, Tsu LV. Anemia and the role of the pharmacist. Arizona J Pharm 2014;12:31?5
2. Khanal R, Karmacharya P, Pathak R, Poudel DR, Ghimire S, Alweis R, et al. Do all patients with acquired methemoglobinemia need treatment? A lesson learnt. J Community Hosp Intern Med Perspect 2015;5:290-79.
3. Turner MD, Karlis V, Glickman RS. The recognition, physiology, and treatment of medication?inducedmethemoglobinemia: A case report. AnesthProg 2007;54:115?7.
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5. Guay J. Methemoglobinemia related to local anesthetics: A summary of 242 episodes. AnesthAnalg 2009;108:837-45.
6. Aslan D, Türköz-Sucak G, Percy MJ. Recessive congenital methemoglobinemia in immediate generations. Turk J Pediatr 2016;58:113-5.
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8. Bradberry SM. Occupational methaemoglobinaemia. Mechanisms of production, features, diagnosis and management including the use of methylene blue. Toxicol Rev 2003;22:13-27.
9. Perera M, Shihana F, Kularathne K, Dissanayake D, Dawson A. Acute methaemoglobinaemia after massive nitrobenzene ingestion. BMJ Case Rep 2009;2009. pii: bcr07.2008.0515.
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15. Evelyn KA, Malloy HT. Microdetermination of oxyhemoglobin, methemoglobin and sulfhemoglobin in a single sample of blood. J BiolChem 1938;126: 655-662.
16. Beutler E. Methemoglobinemia and other causes of cyanosis. In: Beutler E, Lichtman MA, Coller BS, Kipps TJ, eds. Williams Hematology. 5th ed. New York: McGraw-Hill; 1994: 654-662.
17. https://www.medicalnewstoday.com/articles/320396#what-are-the-symptoms.retrived
18. Goldfrank LR, Flomenbaum NE, Lewin NA, Weisman RS, Howland MA, Hoffman RS, editors. Goldfrank'sToxicologic Emergencies. 6th ed. Old Tappan, NJ: Appleton and Lange; 1998.p.1507-23.
19. Wright RO, Lewander WJ, Woolf AD. Methemoglobinemia: Etiology, pharmacology, and clinical management. Ann Emerg Med 1999;34:646-56.
20. Denshaw?Burke M, DelGiacco E, Curran AL, Savior DC, Kumar M.Methemoglobinemia Treatment & Management. Medscape. 2016. Available from: http://www.emedicine.medscape.com/article/204178?treatment#showall.
21. Schirmer RH, Adler H, Pickhardt M, Mandelkow E. “Lest we forget you – Methylene blue.”. Neurobiol Aging 2011;32:2325.e7-16.
References
1. Kucera A, Smith B, Tsu LV. Anemia and the role of the pharmacist. Arizona J Pharm 2014;12:31?5
2. Khanal R, Karmacharya P, Pathak R, Poudel DR, Ghimire S, Alweis R, et al. Do all patients with acquired methemoglobinemia need treatment? A lesson learnt. J Community Hosp Intern Med Perspect 2015;5:290-79.
3. Turner MD, Karlis V, Glickman RS. The recognition, physiology, and treatment of medication?inducedmethemoglobinemia: A case report. AnesthProg 2007;54:115?7.
4. Fan AM, Steinberg VE. Health implications of nitrate and nitrite in drinking water: an update on methemoglobinemia occurrence and reproductive and developmental toxicity. RegulToxicolPharmacol. 1996 Feb. 23(1 pt 1):35-43
5. Guay J. Methemoglobinemia related to local anesthetics: A summary of 242 episodes. AnesthAnalg 2009;108:837-45.
6. Aslan D, Türköz-Sucak G, Percy MJ. Recessive congenital methemoglobinemia in immediate generations. Turk J Pediatr 2016;58:113-5.
7. Burtseva TE, Ammosova TN, Protopopova NN, Yakovleva SY, Slobodchikova MP. Enzymopenic congenital methemoglobinemia in children of the republic of Sakha (Yakutia). J PediatrHematolOncol 2017;39:42-5.
8. Bradberry SM. Occupational methaemoglobinaemia. Mechanisms of production, features, diagnosis and management including the use of methylene blue. Toxicol Rev 2003;22:13-27.
9. Perera M, Shihana F, Kularathne K, Dissanayake D, Dawson A. Acute methaemoglobinaemia after massive nitrobenzene ingestion. BMJ Case Rep 2009;2009. pii: bcr07.2008.0515.
10. Garg D, Edwin N. A case report of methemoglobinemia due to benzonitrile. J Clinic Toxicol 2012;2:131.
11. Methylene Blue Solution for Injection. Medsafe Data Sheet.AFTPharmaceuticals Ltd : 2010.
12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1071541/ retrieved on 27.01.2021.
13. Finch CA. Methemoglobin and sulfhemoglobin. N Engl J Med 1948;239: 470-478. 16.
14. Demedts P, Wauters A, Watelle M, Neels H. Pitfalls in discriminating sulfhemoglobin from methemoglobin [letter]. ClinChem 1997;43: 1098-1099.
15. Evelyn KA, Malloy HT. Microdetermination of oxyhemoglobin, methemoglobin and sulfhemoglobin in a single sample of blood. J BiolChem 1938;126: 655-662.
16. Beutler E. Methemoglobinemia and other causes of cyanosis. In: Beutler E, Lichtman MA, Coller BS, Kipps TJ, eds. Williams Hematology. 5th ed. New York: McGraw-Hill; 1994: 654-662.
17. https://www.medicalnewstoday.com/articles/320396#what-are-the-symptoms.retrived
18. Goldfrank LR, Flomenbaum NE, Lewin NA, Weisman RS, Howland MA, Hoffman RS, editors. Goldfrank'sToxicologic Emergencies. 6th ed. Old Tappan, NJ: Appleton and Lange; 1998.p.1507-23.
19. Wright RO, Lewander WJ, Woolf AD. Methemoglobinemia: Etiology, pharmacology, and clinical management. Ann Emerg Med 1999;34:646-56.
20. Denshaw?Burke M, DelGiacco E, Curran AL, Savior DC, Kumar M.Methemoglobinemia Treatment & Management. Medscape. 2016. Available from: http://www.emedicine.medscape.com/article/204178?treatment#showall.
21. Schirmer RH, Adler H, Pickhardt M, Mandelkow E. “Lest we forget you – Methylene blue.”. Neurobiol Aging 2011;32:2325.e7-16.
2. Khanal R, Karmacharya P, Pathak R, Poudel DR, Ghimire S, Alweis R, et al. Do all patients with acquired methemoglobinemia need treatment? A lesson learnt. J Community Hosp Intern Med Perspect 2015;5:290-79.
3. Turner MD, Karlis V, Glickman RS. The recognition, physiology, and treatment of medication?inducedmethemoglobinemia: A case report. AnesthProg 2007;54:115?7.
4. Fan AM, Steinberg VE. Health implications of nitrate and nitrite in drinking water: an update on methemoglobinemia occurrence and reproductive and developmental toxicity. RegulToxicolPharmacol. 1996 Feb. 23(1 pt 1):35-43
5. Guay J. Methemoglobinemia related to local anesthetics: A summary of 242 episodes. AnesthAnalg 2009;108:837-45.
6. Aslan D, Türköz-Sucak G, Percy MJ. Recessive congenital methemoglobinemia in immediate generations. Turk J Pediatr 2016;58:113-5.
7. Burtseva TE, Ammosova TN, Protopopova NN, Yakovleva SY, Slobodchikova MP. Enzymopenic congenital methemoglobinemia in children of the republic of Sakha (Yakutia). J PediatrHematolOncol 2017;39:42-5.
8. Bradberry SM. Occupational methaemoglobinaemia. Mechanisms of production, features, diagnosis and management including the use of methylene blue. Toxicol Rev 2003;22:13-27.
9. Perera M, Shihana F, Kularathne K, Dissanayake D, Dawson A. Acute methaemoglobinaemia after massive nitrobenzene ingestion. BMJ Case Rep 2009;2009. pii: bcr07.2008.0515.
10. Garg D, Edwin N. A case report of methemoglobinemia due to benzonitrile. J Clinic Toxicol 2012;2:131.
11. Methylene Blue Solution for Injection. Medsafe Data Sheet.AFTPharmaceuticals Ltd : 2010.
12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1071541/ retrieved on 27.01.2021.
13. Finch CA. Methemoglobin and sulfhemoglobin. N Engl J Med 1948;239: 470-478. 16.
14. Demedts P, Wauters A, Watelle M, Neels H. Pitfalls in discriminating sulfhemoglobin from methemoglobin [letter]. ClinChem 1997;43: 1098-1099.
15. Evelyn KA, Malloy HT. Microdetermination of oxyhemoglobin, methemoglobin and sulfhemoglobin in a single sample of blood. J BiolChem 1938;126: 655-662.
16. Beutler E. Methemoglobinemia and other causes of cyanosis. In: Beutler E, Lichtman MA, Coller BS, Kipps TJ, eds. Williams Hematology. 5th ed. New York: McGraw-Hill; 1994: 654-662.
17. https://www.medicalnewstoday.com/articles/320396#what-are-the-symptoms.retrived
18. Goldfrank LR, Flomenbaum NE, Lewin NA, Weisman RS, Howland MA, Hoffman RS, editors. Goldfrank'sToxicologic Emergencies. 6th ed. Old Tappan, NJ: Appleton and Lange; 1998.p.1507-23.
19. Wright RO, Lewander WJ, Woolf AD. Methemoglobinemia: Etiology, pharmacology, and clinical management. Ann Emerg Med 1999;34:646-56.
20. Denshaw?Burke M, DelGiacco E, Curran AL, Savior DC, Kumar M.Methemoglobinemia Treatment & Management. Medscape. 2016. Available from: http://www.emedicine.medscape.com/article/204178?treatment#showall.
21. Schirmer RH, Adler H, Pickhardt M, Mandelkow E. “Lest we forget you – Methylene blue.”. Neurobiol Aging 2011;32:2325.e7-16.