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Correspondence |
Wakayama, Japan
To the Editor:
Serum S-100 B protein is an early and sensitive marker of hypoxic brain damage.1,2 Consequently, levels of this protein may be correlated to neurological outcome after severe bleeding and anemia that decrease cerebral oxygen delivery to critical levels. Since the peak levels of S-100 B protein occur on the third day after a stroke,3,4 we measured S-100 B protein levels three days after severe hemorrhagic shock and immediately thereafter. Two women (one with an anterior placenta previa and the other with anterior vasa previa) at risk from hemorrhage were scheduled for Cesarean delivery under combined spinal-epidural anesthesia. On admission, their hemoglobin concentrations were 11.1 and 9.6 g•dL-1, respectively. In both patients, massive bleeding started immediately after amniotomy. The patient with a placenta previa suffered from decreased systolic blood pressure in the range of 35–55 mmHg, which persisted for 125 min. In contrast, the systolic blood pressure of the patient with vasa previa decreased to 65 mmHg for only two minutes, followed by rapid recovery to 80 mmHg. Although blood had been cross-matched prior to the operation, the hemoglobin level immediately before blood transfusion in both patients was similarly very low (39 g•L-1) because the blood was sent for irradiation after massive bleeding was observed. When hemorrhagic shock occurred, both cases were intubated and ventilated mechanically, and hysterectomy was performed because the uterus failed to contract. In the patient with prolonged shock, S-100 B protein levels analyzed by chemiluminescent immunoassay (SRL Inc., Tokyo Japan) immediately after the operation and on the third postoperative day were 0.24 and 1.04 ng•mL-1, whereas in the patient without shock, these levels were 0.1 and 0.07 ng•mL-1, respectively. The S-100 B protein level in the patient with prolonged shock was above that reported in patients with unilateral supratentorial cerebral infarction (0.5 ng•mL-1).2 Slight extrapyramidal symptoms were noted postoperatively only in the patient with prolonged shock. Brain damage was undetectable by computerized tomography or by magnetic resonance imaging. Our preliminary observation warrants further studies to clarify the significance of increased levels of serum S-100 B protein in severe shock. Measurement of this protein may be useful as a predictor of neurological outcome after life-threatening anemia and hypotension.
References
1 Bottiger BW, Mobes S, Glatzer R, et al. Astroglial protein S-100 is an early and sensitive marker of hypoxic brain damage and outcome after cardiac arrest in humans. Circulation 2001; 103: 2694–8.
2 Wunderlich MT, Ebert AD, Kratz T, Goertler M, Jost S, Herrmann M. Early neurobehavioral outcome after stroke is related to release of neurobiochemical markers of brain damage. Stroke 1999; 30: 1190–5.
3 Buttner T, Weyers S, Postert T, Sprengelmeyer R, Kuhn W. S100 protein: serum marker of focal brain damage after ischemic territorial MCA infarction. Stroke 1997; 28: 1961–5.
4 Missler U, Wiesmann M, Friedrich C, Kaps M. S100 protein and neuron-specific enolase concentrations in blood as indicators of infarction volume and prognosis in acute ischemic stroke. Stroke 1997; 28: 1956–60.
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