Reactions 875 - 27 Oct 2001

SPolygeline

Fatal anaphylaxis in an elderly patient: case reportA 65-year-old man died following anaphylaxis after he had

received polygeline plasma expander [‘Haemaccel’] duringtotal hip replacement under general anaesthesia. He had ahistory of atrial fibrillation and was taking digoxin andfurosemide. Warfarin therapy was replaced by heparininfusion 3 days preoperatively.

The man was stable under general anaesthesia for 90minutes and received polygeline 500ml to cover continuingintra- and postoperative blood loss. However, 2–3 minutesafter infusion of a second unit of polygeline was started, hispulse rate decreased from 80 to 40 beats/min. His pulse tracewas then lost and his QRS complex widened. Although his skinappeared congested, there was no rash or distended neckveins.

Anaesthesia was stopped and the man received 100%oxygen and underwent cardiac compression. His HR increasedto 80 beats/min, according to an ECG, but there was norecordable BP. After 2 bolus doses of epinephrine [adrenaline],there was no response to further epinephrine and the mandied. Autopsy showed no evidence to explain the acute onsetof pulseless electrical activity. One week later, themanufacturers recalled the batch of ‘Haemaccel’ used in thispatient.

Author comment: The manufacturers of ‘Haemaccel’,Hoechst Marrion Roussel, developed an in vitro plasmaactivating substance test that implicated a kinin-mediatedanaphylactoid reaction following administration of‘Haemaccel’. This test is now included in routine quality controlchecks.O’Sullivan S, et al. Kinin-mediated anaphylactoid reaction implicated in acuteintra-operative pulseless electrical activity. Anaesthesia 56: 768-771, Aug 2001 -Ireland 800878392

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Reactions 27 Oct 2001 No. 8750114-9954/10/0875-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved