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Anaphylaxis from topical bovine thrombin (Thrombostat®) during haemodialysis and evaluation of sensitization among a dialysis population


Dr Susan M. Tarlo, MBBS, FRCP(C), Toronto Western Hospital, C4-009, 399, Bathurst St., Toronto, Ontario, Canada M5T 2S8.


Background Topical bovine thrombin (TBT) is used as a topical haemostatic agent in haemodialysis (HD) units and for surgical procedures. It has caused allergic reactions during surgical procedures, but no previous cases have been reported with dialysis usage.

Objective A case is reported of anaphylaxis due to TBT in an HD patient. This led to a determination of whether HD patients exposed to TBT develop specific IgE and IgG antibodies to TBT and an assessment of the frequency of allergic symptoms in HD patients as compared with peritoneal dialysis (PD) patients.

Methods A cross-sectional study of 100 HD and 52 PD patients was performed using a questionnaire to determine allergic symptoms. An ELISA assay was developed to determine TBT-specific IgE and IgG serum antibodies among HD patients. HD patients without TBT exposure and age- and gender-matched blood donors served as controls.

Results Allergic symptoms temporally related to dialysis reported by a questionnaire were significantly more frequent for HD patients than for PD patients: rhinoconjuctivitis 11% vs. 2%, asthma symptoms 20% vs. 6%, urticaria 23% vs. 8% (P values <0.05). Positive TBT-specific IgE and IgG antibodies were more frequent among 65 exposed HD patients (28% for IgE and 26% for IgG) than for controls (4% and 9%), P<0.05.

Conclusions Results indicate the potential for sensitization and clinical allergic responses to beef thrombin when used for haemostasis in HD and suggest that other haemostatic methods should be considered.

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