Rasburicase is considered for rapid lowering of urate in tumour lysis syndrome. Screening for which condition is mandatory before administration?

• A Methylenetetrahydrofolate reductase polymorphism
• B Hereditary fructose intolerance
• C Glucose-6-phosphate dehydrogenase deficiency ✓
• D Pseudocholinesterase deficiency

Explanation

Rasburicase is a recombinant urate oxidase that converts uric acid to allantoin, generating hydrogen peroxide as a byproduct. In G6PD deficiency, red cells cannot regenerate enough glutathione to neutralise this peroxide load, causing haemolysis and methaemoglobinaemia. It is therefore contraindicated in known or suspected G6PD deficiency, which is common in parts of India. Pegloticase carries a similar oxidative concern, while allopurinol and febuxostat do not generate peroxide.

Reference: Goodman and Gilman's The Pharmacological Basis of Therapeutics, 14th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.