Issue |
J Extra Corpor Technol
Volume 16, Number 1, March 1984
|
|
---|---|---|
Page(s) | 37 - 40 | |
DOI | https://doi.org/10.1051/ject/198416137 | |
Published online | 15 September 2023 |
Case Report
Protamine-Induced Allergic Reaction Following Cardiopulmonary Bypass
Indiana University School of Medicine, Indianapolis, IN
* Direct communications to: Robert K. Stoelting, M.D., Department of Anesthesia, Fesler Hall Room 204, 1120 South Drive, Indianapolis, IN 46223
Received:
January
1984
Accepted:
February
1984
A 59 year-old male with a 37-year history of diabetes mellitus treated with protamine zinc insulin (26 units daily) experienced cardiovascular collapse shortly after infusion of protamine (250 mg) at the conclusion of cardiopulmonary bypass for elective coronary artery bypass graft surgery. Generalized erythema of the face and arms and massive facial edema accompanied the hypotension suggesting an allergic reaction to protamine. Presumably, the patient’s prior chronic exposure to low doses of protamine in the insulin preparation (25 units contains 0.7 mg of protamine) caused the formation of antibodies to protamine. The massive dose of intravenous protamine used to reverse heparin anticoagulation relative to that present in the insulin preparation resulted in an antigen-antibody interaction manifesting as cardiovascular collapse.
© 1984 AMSECT
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