Protamine-induced fulminating non-cardiogenic pulmonary edema following cardiopulmonary bypass

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Abstract
Although fulminating non-cardiogenic pulmonary edema followingcardiopulmonary bypass is not a new phenomenon, the exact cause andpathogenesis are still unknown. The causative agent of this potentiallylethal syndrome was hypothesized to be either protamine or blood products.There was no evidence that an antibody-mediated reaction plays a role andpatients were reported to have negative skin tests. We report, for thefirst time, a patient who presented with fulminating non-cardiogenicpulmonary edema after repeated protamine administration with a subsequentpositive skin test to protamine. Specific IgG antibodies to protamine werealso found; however, the level was in the range of that of exposednon-reacting controls. IgE antibodies could not be detected.

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