Severe Dextran-Induced Anaphylactic Shock during Induction of Hypertension-Hypervolemia-Hemodilution Therapy following Subarachnoid Hemorrhage

Abstract

Dextran is a colloid effective for volume expansion; however, a possible side effect of its use is anaphylaxis. Dextran-induced anaphylactoid reaction (DIAR) is a rare but severe complication, with a small dose of dextran solution sufficient to induce anaphylaxis. An 86-year-old female who underwent clipping for a ruptured cerebral aneurysm was admitted to the intensive care unit. Prophylactic hypertension-hypervolemia-hemodilution therapy was induced for cerebral vasospasm following a subarachnoid hemorrhage. The patient went into severe shock after administration of dextran for volume expansion, and dextran administration was immediately discontinued. The volume administered at that time was only 0.8 mL at the most. After fluid resuscitation with a crystalloid solution, circulatory status began to recover. However, cerebral vasospasm occurred and the patient's neurological condition deteriorated. Five weeks after the shock, she was diagnosed with hypersensitivity to dextran by a skin test. When severe hypotension occurs after dextran administration, appropriate treatments for shock should be performed immediately with discontinuation of dextran solution. Although colloid administration is recommended in some guidelines and researches, it is necessary to consider concerning the indication for volume expansion as well as the risk of colloid administration.

Postoperative anticoagulation after free flap reconstruction for head and neck cancer: A systematic review

“…35 Dextran can result in anaphylaxis, pulmonary and cerebral edema, and platelet dysfunction. 36,37 Clinicians must weigh the risks and benefits of each therapy, and may benefit from using a perioperative anticoagulation and free flap salvage algorithm. 38 Inconsistency of anticoagulation protocols was identified within certain studies.…”

“…Heparin can lead to heparin‐induced thrombocytopenia . Dextran can result in anaphylaxis, pulmonary and cerebral edema, and platelet dysfunction . Clinicians must weigh the risks and benefits of each therapy, and may benefit from using a perioperative anticoagulation and free flap salvage algorithm …”

Challenges in the development of nanoparticle‐based imaging agents: Characterization and biology

“…Available data suggest that nanosize is unlikely the driver of these toxicities as they have been observed across various types of materials, including small molecules, microspheres, and nanotechnology‐based contrast agents (Table 5). The composition of these agents does likely play a significant role in determining the toxicity, in that dextrans, iodine, aggregated proteins, and sulfur used in some reactogenic contrast agents are also known for their ability to induce HSR (Dibbern Jr. & Montanaro, 2008; Ring, Stephan, & Brendel, 1979; Shiratori, Sato, Fukuzawa, Kando, & Tanno, 2015). However, some available reports argue against this hypothesis (Scherer, Harr, Bach, & Bircher, 2010).…”

Cytokine and Chemokine Recovery Is Increased by Colloid Perfusates during Dermal Microdialysis

“…Due to known allergic and anaphylactic reactions to dextran solutions [ 55 , 56 , 57 ], we investigated HES 70/0.5, HES 200/0.5, and a 30% lipid emulsion formulation based on soy bean proteins and triglycerides that could be used to replace dextran solutions. Using HES 200/0.5, 90% of macromolecules >100 kDa, such as HES 200, are not expected to pass through the 100-kDa cut-off microdialysis catheter, as indicated by the manufacturer.…”