Esen Gülay, Civi Melek
Department of Anesthesiology and Intensive Care, Sivas Gemerek State Hospital, Sivas, TUR.
Department of Anesthesiology and Intensive Care, Celal Bayar University Training and Research Hospital, Manisa, TUR.
Cureus. 2024 Nov 18;16(11):e73897. doi: 10.7759/cureus.73897. eCollection 2024 Nov.
Methemoglobinemia is a rare but potentially life-threatening condition in which hemoglobin is oxidized, impairing the oxygen-carrying capacity. While congenital forms exist, acquired methemoglobinemia can occur in perioperative settings, especially following exposure to oxidizing agents such as dyes used in sentinel lymph node biopsy (SLNB). Patent Blue V, a synthetic aniline dye commonly used for SLNB, has been associated with rare but serious adverse effects, including methemoglobinemia. We report a case of acquired methemoglobinemia in a 68-year-old female undergoing bilateral modified radical mastectomy with SLNB for breast carcinoma. The patient experienced a sudden and progressive decline in oxygen saturation (SpO2) following administration of 6 ml of 2.5% Patent Blue V. Despite supplemental oxygen therapy, hypoxia persisted, prompting arterial blood gas (ABG) analysis, which confirmed methemoglobinemia (9.2%). Immediate treatment with methylene blue (1 mg/kg) resulted in rapid clinical improvement, with the methemoglobin levels normalizing within eight hours. This case highlights the importance of early recognition and treatment of acquired methemoglobinemia, particularly in a perioperative setting. Patent Blue V is associated with both hypersensitivity reactions and methemoglobinemia, and its interference with pulse oximetry readings can complicate intraoperative monitoring. Prompt administration of methylene blue remains the standard treatment, leading to favorable outcomes. Clinicians should be vigilant regarding the possibility of methemoglobinemia when using dyes such as Patent Blue V during surgical procedures. Diagnostic tools, such as ABG or co-oximetry, are essential for accurate diagnosis, and early treatment with methylene blue can prevent serious complications.
高铁血红蛋白血症是一种罕见但可能危及生命的病症，其中血红蛋白被氧化，损害了携氧能力。虽然存在先天性形式，但获得性高铁血红蛋白血症可发生在围手术期，特别是在接触氧化剂（如前哨淋巴结活检（SLNB）中使用的染料）之后。专利蓝V是一种常用于SLNB的合成苯胺染料，与罕见但严重的不良反应有关，包括高铁血红蛋白血症。我们报告一例68岁女性乳腺癌患者，在接受双侧改良根治性乳房切除术并进行SLNB时发生获得性高铁血红蛋白血症。患者在注射6毫升2.5%专利蓝V后，氧饱和度（SpO2）突然且持续下降。尽管进行了补充氧气治疗，但低氧血症仍然存在，促使进行动脉血气（ABG）分析，证实为高铁血红蛋白血症（9.2%）。立即用亚甲蓝（1毫克/千克）治疗后，临床迅速改善，高铁血红蛋白水平在8小时内恢复正常。该病例强调了早期识别和治疗获得性高铁血红蛋白血症的重要性，特别是在围手术期。专利蓝V与过敏反应和高铁血红蛋白血症均有关联，其对脉搏血氧饱和度读数的干扰会使术中监测复杂化。迅速给予亚甲蓝仍然是标准治疗方法，可带来良好的治疗效果。临床医生在手术过程中使用专利蓝V等染料时，应警惕高铁血红蛋白血症的可能性。诊断工具，如ABG或共血氧测定法，对于准确诊断至关重要，早期使用亚甲蓝治疗可预防严重并发症。
