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January 10, 1977

Severe Anaphylaxis in Cirrhotic Patients Receiving Dextran 40

Author Affiliations

Chaim Sheba Medical Center and Sackler School of Medicine Tel Aviv University Tel Aviv, Israel

JAMA. 1977;237(2):119-120. doi:10.1001/jama.1977.03270290019013

To the Editor.—  This communication was prompted by two near fatal anaphylactoid reactions to dextran 40 (Rheomacrodex) in cirrhotic patients not previously exposed to this drug.During the two-year period ending in August 1976, all patients undergoing vascular operations received dextran 40 routinely for prophylaxis against deep vein thrombosis and for its other properties. Of 158 patients undergoing arterial operations, none had overt cirrhosis and none had any reaction to dextran. However, in two cirrhotic patients of ten undergoing porta-systemic shunts, severe hypotension to nonmeasurable levels and respiratory distress with wheezing developed. One patient had a respiratory arrest. The reactions occurred almost immediately after the infusion was started; no more than 10 to 20 ml had entered the vein. Both patients were successfully resuscitated. No fault was found in the solution or in the infusion set on bacteriological examination, and dextran 40 from the same batches was given to other