title: Protamine-induced fulminating non-cardiogenic pulmonary edema following cardiopulmonary bypass.
abstract: Although fulminating non-cardiogenic pulmonary edema following cardiopulmonary bypass is not a new phenomenon, the exact cause and pathogenesis are still unknown. The causative agent of this potentially lethal syndrome was hypothesized to be either protamine or blood products. There was no evidence that an antibody-mediated reaction plays a role and patients were reported to have negative skin tests. We report, for the first time, a patient who presented with fulminating non-cardiogenic pulmonary edema after repeated protamine administration with a subsequent positive skin test to protamine. Specific IgG antibodies to protamine were also found; however, the level was in the range of that of exposed non-reacting controls. IgE antibodies could not be detected.
authors.affiliation: Department of Anesthesia, University of Basel, Kantonsspital, Switzerland.
authors.forename: C
authors.initials: C
authors.lastname: Kindler
authors.forename: A
authors.initials: A
authors.lastname: Bircher
authors.forename: P
authors.initials: P
authors.lastname: Stulz
mesh_terms: D001014:Aortic Aneurysm / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D004342:Drug Hypersensitivity / Q000175:diagnosis / Q000209:etiology*; D006350:Heart Valve Prosthesis; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007428:Intradermal Tests; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D011479:Protamines / Q000008:administration & dosage / Q000009:adverse effects*; D011654:Pulmonary Edema / Q000139:chemically induced* / Q000175:diagnosis; D012086:Reoperation
chemical_list: D007074:Immunoglobulin G; D011479:Protamines