Changes in tryptase levels during cardiac surgery in patients at low risk for allergic reactions
Keywords:hypersensitivity, anaesthesia, cardiac procedures, protamines, adverse effects, tryptases
Tryptase test can be used as a clinical marker of mast cell activation. The present study is was aimed to identify variations in serum tryptase levels and their possible relationships with allergic reactions to protamine in low-risk patients undergoing cardiac bypass surgery. Thirty patients according to American Society of Anesthesiologists physical status III who underwent cardiac bypass surgery were enrolled. This prospective, non-randomised, clinical study was conducted in an operating room. Venous blood samples for tryptase measurements were obtained from cardiac bypass surgery patients upon admission to the operating room and immediately before and 30 min after the initiation of protamine administration. Signs of allergic reactions were recorded and management steps based on rapid effect response-based clinical assessments for diagnosis and treatment decisions during protamine administrations were described. Serum tryptase levels and clinical signs of allergic reactions, primarily mean arterial pressure (MAP), were recorded. Serum tryptase levels increased significantly and progressively during the bypass procedure (study power, 80%; sample size, 28; power of analysis, 99.8% with α=0.05); however, tryptase levels did not reach a sufficiently high level to confirm an allergic reaction. The MAP and heart rate decreased in 50% of the patients. Although tryptase increased significantly when compared with baseline levels, protamine-associated increases were not significant and failed to provide an unequivocal indication of an allergic response to protamine.
Benoit R, Nougier C, Desmurs-Clavel H, Simon M, Dargaud Y. The modification of the thrombin generation assay for the clinical assessment of hypercoagu¬lability in patients receiving heparin therapy. International Journal of Laboratory Hematology. 2022;44(2):371-8. doi: https://doi.org/10.1111/ijlh.13735
Zhao Y-C, Zhao X, Fu G-W, Liu Q-L, Li H-B. Heparin-free after 3000 IU heparin loaded in veno-venous ECMO supported acute respiratory failure patients with hemorrhage risk: a novel anti-coagulation strategy. Throm¬bosis Journal. 2022;20(1):36. doi: https://doi.org/10.1186/s12959-022-00396-w
Guo F, Zhu X, Wu Z, Wu J, Zhang F. Clinical applications of machine learning in the survival prediction and classification of sepsis: coagulation and heparin usage matter. Journal of Translational Medicine. 2022;20(1):265. doi: https://doi.org/10.1186/s12967-022-03469-6
Chen Y, Phoon PHY, Hwang NC. Heparin Resis-tance During Cardiopulmonary Bypass in Adult Cardiac Surgery. Journal of Cardiothoracic and Vascular Anesthesia. 2022;36(11):4150-60. doi: https://doi.org/10.1053/j.jvca.2022.06.021
To L, Attar D, Lines B, Coba V, Lekura J. Inci-dence of Heparin-Induced Thrombocytopenia in Patients With Newly Implanted Mechanical Circulatory Support Devices. Annals of Pharmacotherapy. 2022;56(5):565-71. doi: https://doi.org/10.1177/10600280211038705
Tian L, Liu Y, Fei Y, Li L, Shi J. Effect of Cle-mastine Fumarate on Perioperative Hemodynamic Instability Mediated by Anaphylaxis During Cardiopulmonary Bypass Surgery. Medical Science Monitor. 2022;28:e936367. doi: https://doi.org/10.12659/MSM.936367
Chiba Y, Otsuka Y, Lefor AK, Sanui M. Efficacy of point-of-care thromboelastography 6s to evaluate platelet function in a patient with pseudothrombocytopenia undergoing cardiopulmonary bypass: a case report. JA Clinical Reports. 2022;8(1):8. doi: https://doi.org/10.1186/s40981-022-00496-6
He Y-Y, Huang Y-P, Wang L, Song B. A case with no administration of protamine to neutralize heparin in aortic valve replacement with cardiopulmonary bypass. Transplant Immunology. 2022;73:101601. doi: https://doi.org/10.1016/j.trim.2022.101601
Asai H, Yamamoto R, Kuromiya K, Kurosaki H, Fukuishi N. A Rapid and Sensitive Determination of His-tamine in Mast Cells Using a Didansyl Derivatization Method. International Archives of Allergy and Immunology. 2022;183(10):1050-5. doi: https://doi.org/10.1159/000525588
Huang W, Zhou X. Anti-histamine effects of dipo¬tassium glycyrrhizinate on lung fibroblasts, impli-cating its therapeutic mechanism for pulmonary fibrosis. The Journal of pharmacy and pharmacology. 2022;74(9):1241-50. doi: https://doi.org/10.1093/jpp/rgac030
De Almeida AD, Silva IS, Fernandes-Braga W, Cassali GD, Klein A. A role for mast cells and mast cell tryptase in driving neutrophil recruitment in LPS-induced lung inflammation via protease-activated receptor 2 in mice. Inflammation Research. 2020;69(10):1059-70. doi: https://doi.org/10.1007/s00011-020-01376-4
Schwartz LB, Metcalfe DD, Miller JS, Earl H, Sullivan T. Tryptase levels as an indicator of mast-cell activation in systemic anaphylaxis and mastocytosis. The New England Journal of Medicine. 1987;316:622-6. doi: https://doi.org/10.1056/NEJM198706253162603
Schwartz LB, Min HK, Ren S, Xia HZ, Hu J, Zhao W. Tryptase precursors are preferentially and spon-taneously released, whereas mature tryptase is retained by HMC-1 cells, Mono-Mac-6 cells, and human skin-derived mast cells. Journal of Immunology. 2003;170:5667-73. doi: https://doi.org/10.4049/jimmunol.170.11.5667
Xie H, Chen L, Zhang H, Wang S, He S. Increased expressions of CD123, CD63, CD203c, and Fc epsilon receptor I on blood leukocytes of allergic asthma. Frontiers in Molecular Biosciences. 2022;9:907092. doi: https://doi.org/10.3389/fmolb.2022.907092
Krishna MT, York M, Chin T, Gnanakumaran G, Heslegrave J, Derbridge C. Multi-center retrospective analysis of anaphylaxis during general anesthesia in the United Kingdom: etiology and diagnostic performance of acute serum tryptase. Clinical and Experimental Immunology. 2014;178:399-404. doi: https://doi.org/10.1111/cei.12424
Fellinger C, Hemmer W, Wohrl S, Sesztak-Greinecker G, Jarisch R, Wantke F. Clinical characteristics and risk profile of patients with elevated baseline serum tryptase. Allergologia et Immunopathologia. 2014;42:544-52. doi: https://doi.org/10.1016/j.aller.2014.05.002
Antunes J, Kochuyt AM, Ceuppens JL. Perioperative allergic reactions: experience in a Flemish referral center. Allergologia et Immunopathologia. 2014;42:348-54. doi: https://doi.org/10.1016/j.aller.2013.08.001
Sokolowska E, Kalaska B, Miklosz J, Mogielnicki A. The toxicology of heparin reversal with protamine: past, present and future. Expert Opinion on Drug Metabolism and Toxicology. 2016;12(8):897-909. doi: https://doi.org/10.1080/17425255.2016.1194395
Chooriyil N, Jom D, Panattil P, Sreedharan S. Protamine-induced hypotension and pulmonary arterial hypertension. Journal of Pharmacology and Pharmaco-therapeutics. 2021;12(1):23-25.
Bircher AJ, Hauser C, Pichler W, Varonier H, Wüthrich B. Importance and indication of specific IgE and IgG antibody determination in allergy diagnostics. Allergologie. 2002;25(6):338-40. doi: https://doi.org/10.5414/ALP25338
Dewachter P, Savic L. Perioperative anaphylaxis: pathophysiology, clinical presentation and management. BJA Education. 2019;19(10):313-20. doi: https://doi.org/10.1016/j.bjae.2019.06.002
Mo Y, Qian Y. Successful re-treatment in a patient with protamine allergy by a slow intravenous injection method. Adverse Drug Reactions Journal. 2020;22(2):117-9.
Pastorello EA, Farioli L, Scibilia G. Baseline tryptase levels are related to age, total IgE, and anti-rPru p 3 IgE levels in peach-allergic patients. Journal of Allergy and Clinical Immunology. 2013;23:127-8.
Blum S, Gunzinger A, Muller UR, Helbling A. Influence of total and specific IgE, serum tryptase, and age on severity of allergic reactions to Hymenoptera stings. Allergy. 2011;66:222-8. doi: https://doi.org/10.1111/j.1398-9995.2010.02470.x
Borer-Reinhold M, Haeberli G, Bitzenhofer M. An increase in serum tryptase even below 11.4 ng mL−1 may indicate a mast cell-mediated hypersensitivity reac¬tion: a prospective study in Hymenoptera venom allergic patients. Clinical and Experimental Allergy. 2011;41:1777-83. doi: https://doi.org/10.1111/j.1365-2222.2011.03848.x
Laroche D, Gomis P, Gallimidi E, Malinovsky JM, Mertes PM. Diagnostic value of histamine and tryptase concentrations in severe anaphylaxis with shock or cardiac arrest during anaesthesia. Anaesthesiology. 2014;121:272-9. doi: https://doi.org/10.1097/ALN.0000000000000276
Baimbetov A, Bizhanov K, Yakupova I, Baira-mov B, Medeubekov U, Madyarov V. Long-term results of simultaneous hybrid ablation of therapy-resistant atrial fibrillation. European Heart Journal. 2020;41:626.
Baimbetov A, Bizhanov K, Yergeshov K, Bayra-mov B, Yakupova I, Bozshagulov T. One year continuous¬ly monitoring follow up results after single procedure atrial fibrillation ablation using cryoballoon second generation. European Heart Journal. 2018;39:1225. doi: https://doi.org/10.1093/eurheartj/ehy566.P5772
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