Diving with G6PD blood disorder

[LexCorp]

I am thinking of getting Scuba certified and was wondering if there are any issues with people that have G6PD deficiency? I've tried searching all over the Internet but there seems to be no information regarding this condition and diving. If anyone knows, please let me know. Thanks.

 

[DocVikingo]

Hi LexCorp,

I, also, was unable to locate any research on diving with G6PD deficiency. This is not surprising and there are no apparent sources of funding for such work.

Most individuals with G6PD blood disorder don't report any symptoms. However, a subset of those with G6PD deficiency do develop anemia after exposure to certain medications (e.g., sulfonamide-based antibacterials), foods (primarily fava beans) or infections. Typically the signs and symptoms of anemia resolve once the cause is identified and removed. In rare cases, chronic anemia may develop.

The diver with one of the variants of this condition will want to assiduously avoid foods and drugs that are known to precipitate attacks of acute anemia and work with their physician to monitor blood status. The latter may involve such techniques a complete blood count (CBC), reticulocyte count and haptoglobin test. Also, care needs to taken to avoid and monitor for infections contracted from the many pathogens in marine environments.

SCUBA should not be undertaken during periods of clinically significant anemia as indicated by signs and symptoms such as fatigue, shortness of breath, dizziness, headache, pale skin or yellowish staining of the skin and whites of the eyes, chest pain, fast or irregular heartbeat, and cognitive problems.

In the well-controlled and otherwise healthy individual G6PD deficiency should not preclude pursuing certification and enjoying SCUBA once he has obtained clearance from his doctor.

Regards,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual and should not be construed as such. Consult with your physician before diving.

 

[TSandM]

I couldn't find anything, either. But it is interesting that the mechanism of injury in G6PD deficiency is an inability to handle oxidative stress. You could certainly posit an increase in oxidative stress when underwater and breathing elevated ppO2s. I think if I had this condition, I'd be very careful with Nitrox mixtures and elevated ppO2s.

 

[iztok]

Would it be prudent to contact DAN and perhaps even volunteer for a chamber ride to evaluate higher ppO2 conditions?

 

[DocVikingo]

But it is interesting that the mechanism of injury in G6PD deficiency is an inability to handle oxidative stress. You could certainly posit an increase in oxidative stress when underwater and breathing elevated ppO2s. I think if I had this condition, I'd be very careful with Nitrox mixtures and elevated ppO2s.

Good point. As carriers of O2, erythrocytes would be at risk from oxidizing free radicals absent the protective effects of G6PD & friends. Although red bloods cells have not been evaluated to the best of my knowledge, some research does indicate that white blood cells can be adversely affected by SCUBA: "The hyperoxia associated to scuba diving leads to a condition of oxidative stress with increased lymphocyte H2O2 production, HO-1 expression, NO synthesis and antioxidant enzyme adaptations in order to avoid oxidative damage." (Free Radic Res. 2007 Mar;41(3):274-81.).

The question is, are the ppO2 elevations and resultant oxidative stress inherent in recreational SCUBA of sufficient intensity and duration to precipitate clinically significant hemolysis/hemolytic anemia in those with G6PD deficiency?

I surely don't know, but among other things one has to consider that these elevations in ppO2 are rather briefer in duration than the typical exposure to oxidative stress that occurs with ingested foods and courses of medications problematic for G6PD blood disorder.

Regards,

Doc

 

[LexCorp]

Thanks for the info guys. I've always known I had G6PD so have always avoided drugs and certain medications and always fill out that I have G6PD on the "other blood conditions" from forms you have to fill out when going to the Dentist, Doctor, Dermatologist, Optometrists etc.

Most of the people don't even know what it is except for the actual Doctors, and I'm not even sure my Doctor will know the effects of Scuba Diving. I've been healthy all my life, rarely ever sick (maybe common colds 1-2 times a year if even that) and live an active lifestyle (surfing, running, weights, sports, etc) and have never had any issues with this disorder.

I think I will consult my Doctor although I highly doubt he will know anything about Scuba diving effects on individuals with G6PD and will just tell me to use caution. Now whether or not to disclose this condition to the Scuba teachers on the medical form that needs to be filled out, I'm not sure...