Department of Orthopaedic Surgery, Children's Hospital Boston, 300 Longwood Ave., Boston, MA 02115, USA.
Spine J. 2012 Aug;12(8):e1-6. doi: 10.1016/j.spinee.2012.08.425.
The use of topical hemostatic agents is widespread and has been shown to reduce bleeding during a wide variety of surgical procedures. Nonetheless, as biologically active agents, there is potential for allergic reactions to these products.
This is a report of intraoperative anaphylaxis to gelatin associated with the use of two topical hemostatic agents.
Case report. There is no outside funding or potential conflict of interest.
A patient with anaphylaxis during anterior spinal fusion.
Laboratory assays for tryptase, gelatin-specific immunoglobulin E (IgE), and total IgE.
A 14-year-old male with myelomeningocele and scoliosis was treated with anterior spinal fusion from T12 to L3. Gelfoam sponges were applied during the preparation of the disc spaces. Approximately 1 hour later, Floseal hemostatic matrix was applied to a briskly bleeding screw hole in the L3 vertebral body, and the patient experienced an abrupt onset of hypotension and ventilatory difficulty. Epinephrine, dexamethasone, and blood products were administered for hemodynamic support while the surgical site was closed. Removal of the drapes revealed a widespread erythematous rash, and the patient was then transferred to the intensive care unit. When stable 3 days later, he returned to the operating room for completion of the spinal fusion.
Postoperative laboratory assays were sent that revealed elevated levels of tryptase, total IgE, porcine, and bovine gelatin-specific IgE. The patient was counseled to avoid gelatin-containing products. At 6-month follow-up, his instrumented spine was radiographically fused and he reported no further allergic issues.
Anaphylaxis may occur because of animal gelatin components of topical hemostatic agents. Previous reports have focused on the thrombin components. Care should be taken in the administration of these products, particularly in the atopic individual.
局部止血剂的使用非常广泛，已被证明可减少各种手术过程中的出血。尽管如此，由于它们是具有生物活性的制剂，因此这些产品仍存在过敏反应的潜在风险。
报告两例使用局部止血剂时与明胶相关的术中过敏反应。
病例报告。无外部资助或潜在利益冲突。
接受前路脊柱融合术时发生过敏反应的患者。
类胰蛋白酶、明胶特异性免疫球蛋白 E（IgE）和总 IgE 的实验室检测。
一名 14 岁男性，患有脊髓脊膜膨出和脊柱侧凸，接受 T12 至 L3 的前路脊柱融合术。在准备椎间盘间隙时使用 Gelfoam 海绵。大约 1 小时后，在 L3 椎体一个快速出血的螺钉孔上应用 Floseal 止血基质，患者出现突然低血压和呼吸窘迫。为了支持血流动力学，给予肾上腺素、地塞米松和血制品，同时关闭手术部位。揭去手术巾后，发现广泛的红斑疹，随后将患者转至重症监护病房。3 天后病情稳定，返回手术室完成脊柱融合术。
术后送检的实验室检测结果显示类胰蛋白酶、总 IgE、猪和牛明胶特异性 IgE 水平升高。建议患者避免使用含明胶的产品。6 个月随访时，他的器械脊柱融合良好，无其他过敏问题报告。
局部止血剂中的动物明胶成分可能导致过敏反应。先前的报告主要集中在凝血酶成分上。在使用这些产品时应谨慎，尤其是在特应性个体中。
