Near-fatal anaphylaxis caused by human serum albumin in fibrinogen and erythrocyte concentrates.
A 40-year-old man developed anaphylactic shock during surgical replacement of a prolapsed mitral valve during general anaesthesia and an attenuated reaction (Grade 2), three days later during a blood transfusion. Human serum albumin, a component of the fibrinogen concentrate used postoperatively with the erythrocyte concentrate, was identified as the trigger, confirmed by positive skin prick and intradermal tests. Any anaphylaxis during the peri-operative period should cause the clinician to perform allergy tests for identification of the culprit drug and, sometimes, culprit additive. Testing of human serum albumin, acting as hidden allergen, should be included, especially where there has been a blood transfusion.
Department of Environmental Dermatology and Venereology, Medical University of Graz, Graz, Austria.
P
P
Komericki
R H
RH
Grims
W
W
Aberer
B
B
Kränke
D000328:Adult; D000707:Anaphylaxis / Q000139:chemically induced*; D000768:Anesthesia, General; D002626:Chemistry, Pharmaceutical; D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D005340:Fibrinogen / Q000008:administration & dosage; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007431:Intraoperative Complications / Q000139:chemically induced*; D008297:Male; D008945:Mitral Valve Prolapse / Q000601:surgery; D019990:Perioperative Care / Q000009:adverse effects / Q000379:methods; D012709:Serum Albumin / Q000009:adverse effects*; D012882:Skin Tests
D012709:Serum Albumin; D005340:Fibrinogen