Anaphylactic Reaction to Protamine Sulfate: A Case Report

Area of Science:

• Cardiology
• Anesthesiology
• Pharmacology

Background:

• Protamine sulfate is essential for reversing heparin anticoagulation in cardiovascular surgery.
• Patients on specific insulin formulations, like insulin lispro protamine, may have unique risks.
• Anaphylactic reactions to protamine sulfate, though rare, are serious adverse events.

Observation:

• A 68-year-old male with type 2 diabetes undergoing coronary artery bypass grafting (CABG) developed anaphylactic shock post-protamine administration.
• Symptoms included tachycardia, hypotension, facial flushing, periorbital edema, and elevated serum tryptase.
• The patient required re-initiation of extracorporeal circulation (ECC) due to instability.

Findings:

• The patient experienced a severe hypersensitivity reaction to protamine sulfate.
• Prompt medical intervention with volume resuscitation, epinephrine, and corticosteroids was initiated.
• Despite treatment, the patient's condition remained unstable, necessitating further surgical intervention.

Implications:

• This case underscores the potential for protamine hypersensitivity, even in patients with specific medication histories.
• Highlights the importance of heightened clinical vigilance and preparedness for managing anaphylaxis during cardiac procedures.
• Emphasizes the need for comprehensive management strategies to prevent and treat protamine-related adverse reactions effectively.