A case with no administration of protamine to neutralize heparin in aortic valve replacement with cardiopulmonary bypass.

Systemic heparinization is necessary before cardiopulmonary bypass (CPB) in cardiac surgery, and protamine administration to neutralize heparin for hemostasis is required at the end of CPB. Because protamine is an allogeneic protein extracted from the sperm of specific fish, serious adverse reactions can occur during clinical application, with potentially catastrophic outcomes. A male patient received aortic valve replacement with CPB. Severe allergic reactions occurred postoperatively after protamine administration for neutralization. Emergency heparinization and CPB re-establishment were conducted with no further hemostatic treatment with protamine. However, the patient suffered a massive hemorrhage and was treated symptomatically with blood transfusion and rehydration. Following two thoracotomies for hemostasis, the patient healed and was eventually discharged. Protamine is irreplaceable as the only hemostatic that neutralizes heparin for cardiac CPB at present. However, because it is an alloprotein, it can cause serious allergic reactions after entering the human body, and caution should be exercised during the process of its clinical application.

[Studies on structure characteristic of polysaccharide P1A from Dicliptera chinensis].

The chemical structures of P1 A was identified by complete acid hydrolysis, partial acid hydrolysis, periodate oxidation-Smith degradation, methylation analysis, IR and NMR. The results showed that P1 A had a backbone consisting rhamnose, mannose, glucose and galactose. The side chain possessed arabinose and xylose. 1-->, 1-->6 and non-reducing terminal linkages existed in polysaccharide P1A, but there are doubling amount of 1-->2 and 1-->4 linkages. Oxidable linkage of P1 A accounted for 45%, and inoxidable linkage of P1A accounted for 55%. Mannose, glucose and galactose were mainly linked by 1-->2 linkage. Rhamnose, arabinose and xylose were mainly linked by 1-->2 and 1-->4 linkages. PlA contained beta-Glc(1,6)-,beta-Gal(1,3)-,beta-Man(1,4)-beta-Rha,-Glc(1,4)-, Glc(1)-,-Gal(1,4)- and Man(1)-.