title: An anaphylactic reaction to protamine sulfate.
abstract: Presented is a case in which protamine sulfate administration caused an immediate allergic-like reaction. The patient, a 50-year-old woman, had received protamine previously to reverse the anticoagulant effect of heparin after open heart surgery. In a similar operation 7 years later, protamine was used again for the same reason. Immediately following intravenous infusion of 3 mg/kg protamine sulfate, a sudden drop of the mean arterial blood pressure to 40 mm Hg occurred, and the heart rate increased from 100 to 130 beats/min. Severe angioneurotic edema of the face and trunk also developed. The reaction was successfully treated with vasopressors, steroids, and volume expansion. Subsequent skin testing revealed a positive reaction to protamine sulfate.
authors.affiliation: Department of Maxillo-Facial Surgery, University of Stellenbosch, Tygerberg, South Africa.
authors.forename: J A
authors.initials: JA
authors.lastname: Roelofse
authors.forename: P
authors.initials: P
authors.lastname: van der Bijl
mesh_terms: D000707:Anaphylaxis / Q000139:chemically induced*; D004342:Drug Hypersensitivity; D004837:Epinephrine / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D011479:Protamines / Q000009:adverse effects*
chemical_list: D011479:Protamines; D008775:Methylprednisolone; D004837:Epinephrine