Journal of Veterinary Clinics (한국임상수의학회지)

The Korean Society of Veterinary Clinics (한국임상수의학회)
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Adverse Reactions to Protamine Sulfate used for Heparin Neutralization in a Dog Receiving a Blood Transfusion

  • Bae, Seulgi (Department of Veterinary Internal Medicine, College of Veterinary Medicine, Kyungpook National University) ;
  • Yun, Sungho (Department of Veterinary Surgery, College of Veterinary Medicine, Kyungpook National University) ;
  • Oh, Taeho (Department of Veterinary Internal Medicine, College of Veterinary Medicine, Kyungpook National University)
  • Received : 2017.04.11
  • Accepted : 2017.06.02
  • Published : 2017.06.30
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Abstract

A 14-year-old castrated male ShihTzu diagnosed with chronic kidney disease (CKD) 6 months prior was referred to our clinic. The patient had been experiencing symptoms such as vomiting, poor appetite and hind limbs weakness. Hematology tests showed that he had a non-regenerative anemia. With aggressive treatment, the patient's state had gotten worse. He showed ragged breath, vomiting blood and loss of consciousness temporarily. Hematocrit maintained low level. Gastric hemorrhage was strongly suspected by hematemesis. Whole blood transfusion was performed and heparin was used as an anticoagulant. Prior to transfusion, the blood cross matching between donor and patient was performed and the result was compatible. After the transfusion was stabilized, 1 mg of protamine sulfate for each 100 units of heparin was prepared and given intravenously over 3 minutes to reverse the effects of heparin. Immediately after protamine injection, the patient conducted severe anaphylactic shock. Protamine sulfate is used to reverse the anticoagulant action of heparin in dogs and humans. The adverse reaction of protamine sulfate range from mild reaction to fetal cardiac arrest. When using protamine sulfate as heparin neutralization, it can lead to the death of a patient cause of anaphylactic shock. For this reason, the protamine sulfate should be injected slowly with antihistamine and the clinician should carefully monitor patients.

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References

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