[Severe dextran-induced anaphylactic/anaphylactoid reaction despite preventive hapten administration]

Dextran-60 is widely used as a colloid volume substitute and for thromboprophylaxis. In order to avoid the most dangerous complication associated with dextran, the dextran-induced anaphylactic/anaphylactoid reaction (DIAR), hapten dextran is infused before starting the first application of dextran. We report of a 60-year-old man with multiple trauma, who received a dextran infusion for thromboprophylaxis because of high risk for thrombosis due to a severe thrombocytosis developing in the late postoperative period. Despite prophylaxis with monovalent hapten dextran, an anaphylactic reaction occurred. Although a serum sample drawn prior to the reaction is lacking, the causal relationship to dextran can be classified as likely, due to the close time relationship to the dextran-60 infusion. In addition, there were high titers of dextran-reactive antibodies in the blood drawn immediately after the reaction occurred. It is concluded that even after correct application of monovalent hapten dextran, dextran infusions carry the risk of severe anaphylactic reactions. They should therefore only be administered if clinical observation of the patient and the possibility of resuscitation are guaranteed.