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Anaphylactic shock to fresh-frozen plasma inactivated with methylene blue

Karine Nubret1, Martine Delhoume, Isabelle Orsel

  • 1Service Anesthésie Réanimation Chirurgicale, Unité d'Hémovigilance, Laboratoire d'Immunologie, Faculté de Médecine, Limoges, France.

Transfusion
|July 30, 2010
PubMed
Abstract

Insights

Methylene blue allergy can cause severe anaphylactic reactions during fresh-frozen plasma (FFP-MB) infusions. These cases highlight potential safety concerns with FFP-MB, particularly in post-cardiac surgery patients.

Area of Science:

  • Anesthesiology and Critical Care Medicine
  • Transfusion Medicine
  • Allergy and Immunology

Background:

  • Methylene blue allergy is a known condition.
  • Virus inactivation using methylene blue in fresh-frozen plasma (FFP-MB) is used in France.
  • FFP-MB has been used for years in Europe.

Observation:

  • Two patients experienced anaphylactic shock during FFP-MB infusion after cardiac surgery.
  • Symptoms included generalized rash.
  • Reactions were managed with epinephrine or extracorporeal circulatory support.

Findings:

  • Allergy was suspected due to timing, lack of other allergens, and rash.
  • Methylene blue allergy was confirmed via skin tests (prick and intradermal) with methylene blue and patent blue.
  • Basophil activation tests further validated the dye's role in the anaphylactic reaction.

Implications:

  • These cases raise questions about the safety of FFP-MB.
  • Further investigation into FFP-MB safety is warranted.
  • Clinicians should be aware of potential methylene blue allergy in FFP-MB transfusions.

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