Allergy Asthma Immunol Res.  2018 Mar;10(2):184-186. 10.4168/aair.2018.10.2.184.

A Case of Intraoperative Anaphylaxis Caused by Bovine-Derived Thrombin

• Park HJ
• Suk KS
• Park JW

• KMID: 2402980
• DOI: http://doi.org/10.4168/aair.2018.10.2.184

Abstract

Intraoperative bovine-derived topical thrombin is still widely used for hemostasis during surgery. A 38-year-old woman with chronic spontaneous urticaria was referred to the orthopedic surgery department for herniated disk and myelopathy. During the first stage of operation, bovine-derived thrombin powder soaked in Gelfoam was used as a hemostatic aid. After 30 minutes, the patient developed anaphylactic shock with systemic skin rash and angioedema. Repeated intravenous bolus and infusion of vasopressor were carried out, and her blood pressure normalized. Skin test and specific immunoglobulin E test showed positive results for bovine thrombin and beef, respectively. During the second stage of operation (After 10 days from first stage of operation), bovine-derived thrombin powder was excluded and the operation was successful without any unexpected events. Therefore, bovine thrombin should be used with caution because it might cause anaphylaxis.

Keyword

Anaphylaxis; bovine; thrombin

MeSH Terms

Adult
Anaphylaxis*
Angioedema
Blood Pressure
Exanthema
Female
Gelatin Sponge, Absorbable
Hemostasis
Humans
Immunoglobulin E
Immunoglobulins
Intervertebral Disc Displacement
Orthopedics
Red Meat
Skin Tests
Spinal Cord Diseases
Thrombin*
Urticaria
Immunoglobulin E
Immunoglobulins
Thrombin

Figure

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  Fig. 1 Rash and facial angioedema of the patient.

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  Fig. 2 Skin prick test (A) and intradermal test (B). The black line of circle reveals the outline of wheal.

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