Methemoglobin Reductase, Blood
Confirming cases of heterozygous or homozygous methemoglobin reductase deficiency
Genetic studies in families with methemoglobin reductase deficiency
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Methemoglobin reductase, also called "diaphorase," and more properly called cytochrome B5 reductase, is the only enzyme within the erythrocyte that maintains hemoglobin in the reduced (non-methemoglobin) state.
Persons who are heterozygous for methemoglobin reductase deficiency have no clinical or laboratory abnormalities, are not cyanotic, and have normal methemoglobin concentrations in their blood.
Persons who are homozygous for methemoglobin reductase deficiency have normal arterial oxygen saturation but have varying quantities of methemoglobin in their blood, generally 15% to 20%, and are quite cyanotic. Paradoxically, homozygotes have normal blood counts; the condition does not cause polycythemia. The reason for this apparent paradox seems to be that the presence of methemoglobin shifts the hemoglobin-O2 dissociation curve to the right, so that although the transport of oxygen is diminished, the delivery of oxygen to tissues is normal. The condition is quite benign, but may cause concern to parents of affected children, be a cosmetic embarrassment to the children, and alarm the attending physician. The cyanosis may be treated with methylene blue.
Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
> or =12 months: 6.6-13.3 U/g Hb
Reference values have not been established for patients who are <12 months of age.
Methemoglobin reductase activity in neonates (0-6 weeks) is normally 60% of the normal adult value. Adult values are attained by 2 to 3 months of age.
Heterozygotes have results slightly lower than the reference range. Homozygotes demonstrate little to no methemoglobin reductase activity and increased levels of methemoglobin.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
Individuals who are glucose-6-phosphate-dehydrogenase (G-6-PD) deficient are not candidates for methylene blue therapy. Administration of methylene blue to such persons will cause hemolysis or methemoglobin formation.
Clinical Reference Provides recommendations for further in-depth reading of a clinical nature
Beutler E: Methemoglobinemia and other causes of cyanosis. In Williams Hematology. Sixth edition. Edited by E Beutler, M Lichtman, WJ Williams, TJ Kipps. New York, McGraw-Hill Book Company, 2001, p 611