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Canadian Journal of Anesthesia, Vol 32, 49-52, Copyright © 1985 by Canadian Anesthesiologists' Society

Clinical Reports: Thrombocytopenia Accompanying a Reaction to Protamine Sulfate

JAN CHARLES HORROW MD1

1 Department of Anesthesia, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115

Address correspondence to: Dr. Jan Charles Horrow, Department of Anesthesia, Hahnemann University, Broad and Vine Streets, Philadelphia PA, 19102

Catastrophic pulmonary vasoconstriction, an idiosyncratic reaction to protamine, occurred following cardiopulmonary bypass in a patient with mitral regurgitation. One minute following intravenous injection of 10 mg of protamine, systemic blood pressure decreased precipitously, accompanied by elevated pulmonary arterial pressure, decreased left atrial pressure, and a dilated and poorly contracting right ventricle. These changes spontaneously reversed over five minutes. Rechallenge with protamine was uneventful. Platelet count decreased from 76,000/mm3 to 12,000/mm3. Transient thrombocytopenia occurs predictably in dogs given protamine rapidly. Suggested mechanisms of idiosyncratic pulmonary vasoconstriction in patients should consider the role of the associated thrombocytopenia.

Key Words: ALLERGY: protamine, anaphylactoid reactions, mediators, complement • BLOOD, COAGULATION: protamine • COMPLICATIONS: hypotension • LUNG: vasoconstriction






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Copyright © 1985 by the Canadian Anesthesiologists' Society.