Low-molecular weight heparins (LMWHs) are widely used during haemodialysis. We recently observed a patient who developed a severe allergic reaction after administration of an LMWH (reviparin). The patient, a 52-year-old women suffering from end-stage renal disease caused by diabetic nephropathy, started haemodialysis in March 2003. She had a past history of hepatitis C with a severe anaphylactic reaction after administration of interferon-. From the first haemodialysis session, she experienced serious respiratory problems which required treatment with aminophylline and oxygen. Dyspnoea, cough and wheezing occurred during the dialysis sessions, and she recovered completely after the attacks. Bicarbonate dialysis, 4 h per session, three times per week, with polysulfone dialysers (Fresenius®) was performed, with no re-use of dialyser. From March to May, reviparin was used as anticoagulant therapy. The patient had never used angiotensin-converting enzyme (ACE) inhibitors. The patient was switched to another polysulfone dialyser brand (Gambro®) after 1 month, but with no improvement in respiratory status. IgE was 588 kIU/l (normal range up to 114 kIU/l). There was no eosinophilia in the peripheral blood. In May 2003, nasal bleeding caused by hypertension occurred requiring posterior nasal tamponade. Her platelets were within the normal range, as were her coagulation parameters. She was then dialysed without reviparin and her overall status significantly improved. She had no respiratory problems. In July 2003, 45 days after the last episode of severe nasal bleeding, reviparin was introduced as anticoagulant therapy. Respiratory distress recurred, this time followed by bullous skin changes on the lower extremities. All symptoms disappeared after discontinuation of reviparin.
After searching the WHO databases and Medline, to the best of our knowledge, this is the first case of a haemodialysis patient who developed an anaphylactic reaction after administration of reviparin. Ueda et al. described an anaphylactoid reaction induced by dalteparin sodium in a haemodialysis patient [1]. We would like to warn colleagues that anticoagulation with LMWH in haemodialysis patients with a known allergic predisposition can cause serious anaphylactic reactions.
Conflict of interest statement. None declared.
Department of Dialysis Clinical Hospital Centre Zagreb Zagreb Croatia Email: nina_basic{at}net.hr
References