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October 1970

Acute Methemoglobinemia and Hemolytic Anemia Due to Toluidine Blue

Author Affiliations

Washington, DC
From the departments of surgery (Dr. Teunis) and medicine (Drs. Leftwich and Pierce), Washington Hospital Center, Washington, DC.

Arch Surg. 1970;101(4):527-531. doi:10.1001/archsurg.1970.01340280079021

Methemoglobinemia and severe self-limiting hemolytic anemia due to glucose-6-phosphate dehydrogenase (G-6-PD) deficiency appeared after intravenous use of toluidine blue to visualize parathyroid tissue during subtotal thyroidectomy. Determination of G-6-PD should be a part of the patient's preoperative baseline laboratory study when the use of toluidine blue is contemplated. If deficiency is documented, the drug should be administered only in an extraordinary circumstance and after adequate preparation to project the susceptible patient.