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Two Cases of Hypersensitivity Reactions Caused by Human Serum Albumin During Therapeutic Plasma Exchange
Laboratory Medicine Online ; : 107-112, 2019.
Article in English | WPRIM | ID: wpr-760481
ABSTRACT
Iso-oncotic human serum albumin (HSA) is the primary replacement fluid of choice during therapeutic plasma exchange (TPE). Hypersensitivity reactions to HSA are rare, but require proper evaluation and management. In this article, we report two cases of hypersensitivity reactions to 5% HSA during TPE and discuss strategies to address this problem. The first case was a 60-year-old female patient, who was scheduled for TPE for treatment of recurrent focal segmental glomerulosclerosis after ABO-incompatible kidney transplantation. She developed a pruritic rash on her entire body during the first two sessions of TPE using 5% HSA. The third session was conducted using 500 mL normal saline, 1,000 mL 10% pentastarch, and 750 mL 5% HSA, where she eventually developed a pruritic rash when HSA was infused. There were no adverse events during the fourth and fifth session when fresh frozen plasma was used in place of HSA. The second case was a 50-year-old male patient diagnosed with optic neuritis, who was admitted for five sessions of TPE. The patient developed a pruritic rash on his entire body during the first session of TPE using 5% HSA. The patient experienced no adverse events during the following four sessions using fresh frozen plasma. Certain elements contained in HSA, such as albumin aggregates, prekallikrein activator, and caprylate-modified albumin, might be the reason for these hypersensitivity reactions. Careful selection of alternative replacement fluids is important to avoid premature termination of TPE procedures and secure optimal treatment options for patients.
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Full text: Available Index: WPRIM (Western Pacific) Main subject: Plasma / Plasma Exchange / Serum Albumin / Caprylates / Glomerulosclerosis, Focal Segmental / Factor XIIa / Optic Neuritis / Hydroxyethyl Starch Derivatives / Kidney Transplantation / Exanthema Limits: Female / Humans / Male Language: English Journal: Laboratory Medicine Online Year: 2019 Type: Article

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Full text: Available Index: WPRIM (Western Pacific) Main subject: Plasma / Plasma Exchange / Serum Albumin / Caprylates / Glomerulosclerosis, Focal Segmental / Factor XIIa / Optic Neuritis / Hydroxyethyl Starch Derivatives / Kidney Transplantation / Exanthema Limits: Female / Humans / Male Language: English Journal: Laboratory Medicine Online Year: 2019 Type: Article