Thrombin
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Allergic reaction: case report An 82-year-old woman developed an allergic reaction to thrombin, which was administered to achieve pseudoaneurysm thrombosis. The woman was admitted due to frequent ventricular premature contractions, for which she underwent a radiofrequency ablation of the culprit tissue via the right femoral artery. Twenty-four hours following successful procedure, the bandage compressing the puncture was taken off. After 48 hours, she complained about pain in the area of artery puncture at her right lower limb. Upon detailed investigation, formation of pseudoaneurysms in the right femoral artery was noted. Due to failure of compression using bandage, pseudoaneurysm thrombosis could not be achieved. Therefore, she was subjected to ultrasound-guided percutaneous injection of thrombin [dose not stated] into the pseudoaneurysmal sac, and successful thrombosis was achieved. However, one hour after administration of thrombin, she developed tremble, nausea, tightness in the chest, drop in BP and a high fever of 38.9oC. Laboratory investigations revealed critical decrease in leukocyte count (WBC: 0.87×109/L), progressive decrease in platelet and haemoglobin, progressive increase in D-dimer and fibrin/ fibrinogen degradation products and liver dysfunction (ALT: 409 U/L). ECG demonstrated T-wave inversion in leads V4–V6 and ST-segment depression. On the basis these findings and symptoms, an allergic reaction to thrombin was diagnosed. The woman received dexamethasone, dopamine, fluid infusion, oxygen inhalation, suspension RBC, supportive liver protection therapy, fresh frozen plasma and other unspecified symptomatic treatments under BP, ECG and SpO2 monitoring. Her vital signs stabilised, and the results of a repeat lab investigation improved. Author comment: "For the case presented here, it was highly suspected that an allergic reaction to thrombin occurred after thrombin injection." Ha L, et al. A possible allergic reaction case to thrombin injected into pseudoaneurysm after radiofrequency ablation. American Journal of Case Reports 20: 1497-1499, 11 Oct 2019. Available from: URL: http://doi.org/10.12659/ 803439559 AJCR.916949 - China
0114-9954/19/1783-0001/$14.95 Adis © 2019 Springer Nature Switzerland AG. All rights reserved
Reactions 14 Dec 2019 No. 1783
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