D2I2.
genetic⚑ High burden in India

G6PD deficiency

Glucose-6- dehydrogenase (G6PDD), also known as favism, is the most common deficiency worldwide. It is an inborn error of that to red blood cell breakdown. Most of the time, those who are affected have no symptoms. Following a specific trigger, symptoms such as yellowish skin, dark urine, shortness of breath, and feeling tired may develop. can include anemia and newborn . Some people never have symptoms.

Underlined words are explained — tap any of them.

Symptoms — what it feels like

  • ·Yellowish skin, dark urine, shortness of breath

Causes — why it happens

  • · ( )

Treatment

  • ·Avoiding triggers, medications for , stopping offending medication, blood

Complications

  • ·, newborn
The genetics, in one picture

How common each gene variant is, by ancestry

The share of people carrying the effect version of each variant. South Asian is highlighted; where it differs from European, a risk model built on Europeans can misread it.

African
13%
Admixed American
1%
East Asian
0%
European
0%
South Asian · 1000G (n≈489)
0%

Effect-allele frequencies. All-India is the pooled large-sample number from GenomeIndia (≈10,000 Indian genomes); the South-Asian row is the smaller 1000 Genomes phase-3 panel, kept for finer per-subpopulation resolution.

Did you know?
The G6PD gene variant the world tracks is absent in Indians - but the deficiency isn't
The African A- variant is 0% in 1000 Genomes South Asians; India's deficiency runs on its own variants - Orissa, Kalyan-Kerala, Mediterranean.
↓ Card
Source: 1000 Genomes phase 3 / D2I2 dossier
India's malaria cure can be dangerous for the ~1 in 50 who carry a hidden enzyme flaw
G6PD deficiency affects ~1.9% of Indians (up to 6% in some groups); primaquine, which clears relapsing malaria, can trigger red-cell breakdown in them.
↓ Card
Source: Blood Cells Mol Dis 2020
The Indians most likely to have G6PD deficiency are the ones global gene panels sampled least
India's malaria-endemic tribal belts carry both the most deficiency and India-specific variants, yet urban 1000 Genomes samples largely miss them.
↓ Card
Source: D2I2 dossier (tribal-sampling whitespace)
For people with G6PD deficiency, fava beans and mothballs really can trigger a crisis
Most carriers are healthy; problems come only from specific triggers - fava beans, naphthalene mothballs, certain antimalarials and infections.
↓ Card
Source: MedlinePlus (NIH)

The sections below are general education drawn from public guidelines (NHS, Mayo, CPIC, WHO, ICMR). They are not individually reviewed by a clinician and are not medical advice — always talk to a doctor about your own health.

When to see a doctor

See a doctor

See a doctor if you or your child suddenly become pale, very tired, or short of breath, or notice yellowing of the eyes or dark-coloured urine, especially after an infection, certain foods (like fava beans), or a new medicine. This inherited condition can cause red blood cells to break down.

Get care urgently

Get urgent care for deep yellowing of the skin or eyes, very dark or red-brown urine, fast breathing, a racing heart, or extreme weakness. In a newborn, seek prompt care for strong yellowing (jaundice).

General guidance, not a diagnosis. When in doubt, see a doctor.

Questions to ask your doctor

  • ?Which blood test confirms this?
  • ?Which foods, medicines, and chemicals should we avoid?
  • ?Should other family members be tested?
  • ?What early signs mean red blood cells are breaking down?
  • ?What should I tell other doctors or pharmacists before any new medicine?
  • ?How is this monitored over time?

What to note before your visit

  • ·what triggered past episodes (food, illness, or medicine)
  • ·any pale skin, yellow eyes, or dark urine
  • ·family history of this condition
  • ·a list of all medicines and supplements taken
For clinicians · pharmacogenomics

Genes that change how certain drugs work — and that differ in South Asians. This is education, not a dosing tool; genotype-guided prescribing is a clinician decision.

G6PDOxidative drugs: primaquine, tafenoquine, dapsone, rasburicase, nitrofurantoin, sulfonamides
CPIC A

Some people are born with red blood cells that can't handle certain 'stressful' medicines. Give those drugs and the red cells burst, causing sudden . A simple blood test tells the doctor whether a drug like an anti-malaria pill is safe for that person.

South Asian signal: G6PD deficiency is common across India: an all-India systematic review found an overall ~1.9% prevalence (range 0.8-6.3%), but tribal/vulnerable groups run far higher - ~7.7% overall in tribal communities and up to ~27% in some groups. The G6PD Mediterranean (563C>T) variant, a severe (Class II) variant, is the commonest deficient allele in India (~60% of deficient cases), so many Indian deficients are the high-risk severe type.

Prescriber note: Screen for G6PD status before prescribing primaquine/tafenoquine (radical cure of vivax malaria), dapsone, or rasburicase; rasburicase is contraindicated in G6PD deficiency. Because the severe Mediterranean variant predominates in India, do not assume mild African-type deficiency. CPIC advises that in G6PD-deficient individuals, drugs with haemolytic potential (e.g. rasburicase - formally contraindicated; primaquine, dapsone, and other listed oxidants) should be avoided or used only with explicit risk-benefit justification and monitoring, and that higher-risk ancestries be screened before such drugs.

Not a dosing tool. Genotype-guided prescribing is a clinician decision; genotyping access in India is limited.

Myths vs facts

G6PD deficiency is a contagious disease you can catch from someone.
is not something you catch — it is an inherited condition you are born with, caused by a change in a gene on the X (which is why it is more common in boys). It affects an that normally protects red blood cells.Treating it as an infection causes needless fear; it is simply an inherited trait that can be managed by knowing your triggers.
A child with G6PD deficiency is sickly and can never live a normal life.
Most people with are perfectly healthy and have no symptoms at all. Problems — red blood cells breaking down, causing and — happen only when specific triggers are encountered. So it is about avoiding those triggers, not about being constantly ill.Knowing a child has G6PD deficiency lets a family prevent problems, rather than assume a life of illness.
It makes no difference what a person with G6PD deficiency eats or which medicines they take.
This is the part with real nuance: certain triggers CAN set off a sudden reaction. These include fava/broad beans (this is called favism), some medicines (certain antimalarials, some sulfa and others), mothballs (naphthalene), and . A person with should tell their doctor about their condition and avoid known triggers — and should always check medicines with a doctor rather than skipping needed treatment out of fear.Because some common antimalarials and household mothballs are triggers, knowing a person's G6PD status before treatment can prevent a dangerous reaction.
Yellow skin (jaundice) in a G6PD-deficient newborn is caused by the mother's sins or the evil eye.
Newborn in is a known medical effect of red blood cells breaking down — not a curse or bad luck. It is treatable (for example with light therapy), and early testing lets families watch for and prevent problems.Blaming the mother or the evil eye delays simple, effective care for a treatable newborn condition.
An open question — could you help answer it?

Across the other high- (india) gene set (), 17 -'' are actually seen in South Asians () - many European-absent and still clinically 'uncertain'. For g6pd , that's a pool of computationally-damaging, India-relevant, clinically-unresolved variants no one has systematically characterised.

A study that would help: Take the South-Asian-observed, European-absent, ClinVar-uncertain in and them for g6pd : functional or family segregation to move them from 'uncertain' to a real call. Each is a usable diagnostic result.

Genomics deep dive · verified

The enzyme flaw that turns a routine malaria cure into an emergency — with India-only variants the reference data misses

The finding

affects about 1.9% of Indians (up to ~6% in some groups). The catch: , the drug that clears relapsing P. vivax malaria, triggers dangerous red-cell breakdown in deficient people — so India's malaria-elimination push runs straight into a wall.

Why India specifically

India's malaria- zones overlap its tribal belts, which carry both the most malaria and the most . And the are partly India-specific — Orissa and Kalyan-Kerala alongside the Mediterranean type. Crucially, the urban South-Asian samples in global reference panels () largely miss these tribal variants: a blind spot inside the blind spot.

What's known — and the gap

The major are catalogued, and point-of-care testing before is the known safeguard. The gap is coverage: tribal and India-specific variants are under-represented in reference data, so a 'normal' result can still miss real .

A study you could fund

Sequence across under-sampled Indian tribal populations, map the India-specific , and validate whether standard tests catch them before radical-cure is given.

Plain-language summary adapted from Wikipedia. Not medical advice.