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Glucose-6-phosphate dehydrogenase deficiency

Last reviewed: 17 May 2025
Last updated: 21 Jun 2023

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • jaundice
  • pallor
  • dark urine
Full details

Other diagnostic factors

  • nausea
  • cataract
  • splenomegaly
Full details

Risk factors

  • male sex
  • neonate
  • ethnic origin in the Mediterranean, sub-Saharan Africa, Middle East, or Southeast Asia
  • family history
  • recent exposure to oxidative drugs
  • infection
  • recent exposure to broad beans (favism)
Full details

Diagnostic investigations

1st investigations to order

  • FBC
  • reticulocyte count
  • urinalysis
  • unconjugated (indirect) bilirubin
  • lactate dehydrogenase (LDH)
  • haptoglobin
  • peripheral blood smear
Full details

Investigations to consider

  • G6PD fluorescent spot test
  • G6PD spectrophotometry
  • molecular analysis
Full details

Emerging tests

  • point of care testing

Treatment algorithm

ACUTE

acute haemolysis

neonates with prolonged indirect hyperbilirubinaemia

ONGOING

chronic non-spherocytic haemolytic anaemia

Contributors

Authors

Atul Bhanu Mehta, MA, MD, FRCP, FRCPath

Professor of Haematology and Consultant Haematologist

Royal Free Hospital and University College London School of Medicine

London

UK

Disclosures

ABM declares that he has no competing interests.

Peer reviewers

Lucio Luzzatto, MD

Professor of Hematology

University of Firenze

Florence

Italy

Disclosures

LL declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

WHO Working Group. Glucose-6-phosphate dehydrogenase deficiency. Bull World Health Organ. 1989;67(6):601-11. Abstract

Cappellini MD, Fiorelli G. Glucose-6-phosphate dehydrogenase deficiency. Lancet. 2008 Jan 5;371(9606):64-74. Abstract

Mason PJ, Bautista JM, Gilsanz F. G6PD deficiency: the genotype-phenotype association. Blood Rev. 2007 Sep;21(5):267-83. Abstract

Roper D, Layton M, Rees D, et al. Laboratory diagnosis of G6PD deficiency. A British Society for Haematology Guideline. Br J Haematol. 2020 Apr;189(1):24-38.Full text  Abstract

Cappellini MD, Fiorelli G. Glucose-6-phosphate dehydrogenase deficiency. Lancet. 2008;371:64-74. Abstract

World Health Organization. Guide to G6PD deficiency rapid diagnostic testing to support P. vivax radical cure. Jul 2018 [internet publication].Full text

Luzzatto L, Nannelli C, Notaro R. Glucose-6-phosphate dehydrogenase deficiency. Hematol Oncol Clin North Am. 2016 Apr;30(2):373-93. Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Differentials

    • Sickle cell disease
    • Autoimmune haemolytic anaemia
    • Isoimmune haemolytic anaemia: for example, ABO incompatibility
    More Differentials
  • Guidelines

    • Clinical practice guideline revision: management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation
    • Laboratory diagnosis of G6PD deficiency. A British Society for Haematology Guideline
    More Guidelines
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