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A continual supply of reduced glutathione is required to protect red blood cells against the toxic effects of primaquine, a malarial prophylactic. Why would individuals with a defect in the enzyme glucose 6-phosphate dehydrogenase (G6PDH) be susceptible to primaquine-induced hemolytic anemia?The enzyme G6PDH is indirectly responsible for increasing levels reactive oxygen species in cells, so defective G6PDH leads to anemia.Individuals with a G6PDH deficiency detoxify primaquine in the kidneys instead of the liver, which results in primaquine-induced hemolytic anemia.A G6PDH deficiency leads to insufficient NADPH, which is required to maintain high levels of reduced glutathione.Individuals with a G6PDH deficiency are susceptible to anemia because they cannot release glucose from liver cells in response to glucagon.

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