Clinical Information

Methemoglobin:

When iron in hemoglobin is oxidized from the normal divalent state to a trivalent state, the resulting brownish pigment is methemoglobin. Methemoglobin cannot combine reversibly with oxygen and is associated with cyanosis.

Methemoglobinemia, with or without sulfhemoglobinemia, is most frequently encountered as a result of administration of medications such as phenacetin, phenazopyridine, sulfonamides, local anesthetics, dapsone, or following ingestion of nitrites or nitrates. Congenital methemoglobinemias are rare. They are due to either:

-Deficiency of methemoglobin reductase (also called cytochrome B5 reductase or diaphorase) in erythrocytes, an autosomal recessive disorder

-One of several intrinsic structural disorders of hemoglobin, called methemoglobin-M; all autosomal dominant in inheritance

Methemoglobinemia responds to treatment with methylene blue or ascorbic acid.

Sulfhemoglobin:

Sulfhemoglobin cannot combine with oxygen. Sulfhemoglobinemia is associated with cyanosis and often accompanies drug-induced methemoglobinemia. Sulfhemoglobinemia can be due to exposure to trinitrotoluene or zinc ethylene bisdithiocarbamate (a fungicide), or by ingestion of therapeutic doses of flutamide.

In contrast to methemoglobinemia, sulfhemoglobinemia persists until the erythrocytes containing it are destroyed. Therefore, the blood level of sulfhemoglobin declines gradually over a period of weeks.

Patients with sulfhemoglobinemia often also have methemoglobinemia. There is no specific treatment for sulfhemoglobinemia. Therapy is directed at reversing the methemoglobinemia if present.