06/17/2026
Methemoglobin reductase testing evaluates the activity of the enzyme system responsible for converting methemoglobin (Fe³⁺) back to functional hemoglobin (Fe²⁺), allowing normal oxygen transport. The primary enzyme involved is cytochrome b5 reductase (NADH-dependent methemoglobin reductase). Testing is used to investigate congenital methemoglobinemia, particularly cases caused by CYB5R3 gene mutations, which result in reduced enzyme activity and persistent elevation of methemoglobin levels. The assay is performed using a blood sample and measures the ability of erythrocytes to reduce methemoglobin. Decreased enzyme activity supports a diagnosis of hereditary methemoglobinemia and helps differentiate it from acquired causes due to oxidant exposure or medication.