PMID- 23021035
OWN - NLM
STAT- MEDLINE
DCOM- 20130102
LR  - 20121001
IS  - 1878-1632 (Electronic)
IS  - 1529-9430 (Linking)
VI  - 12
IP  - 8
DP  - 2012 Aug
TI  - Intraoperative anaphylaxis to gelatin in topical hemostatic agents during 
      anterior spinal fusion: a case report.
PG  - e1-6
LID - S1529-9430(12)00987-4 [pii]
LID - 10.1016/j.spinee.2012.08.425 [doi]
AB  - BACKGROUND CONTEXT: 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. PURPOSE: This is a report of intraoperative 
      anaphylaxis to gelatin associated with the use of two topical hemostatic agents. 
      STUDY DESIGN: Case report. There is no outside funding or potential conflict of 
      interest. PATIENT SAMPLE: A patient with anaphylaxis during anterior spinal 
      fusion. OUTCOME MEASURES: Laboratory assays for tryptase, gelatin-specific 
      immunoglobulin E (IgE), and total IgE. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
CI  - Copyright (c) 2012 Elsevier Inc. All rights reserved.
FAU - Spencer, Hillard T
AU  - Spencer HT
AD  - Department of Orthopaedic Surgery, Children's Hospital Boston, 300 Longwood Ave., 
      Boston, MA 02115, USA. Hillard.Spencer@childrens.harvard.edu
FAU - Hsu, Joyce T
AU  - Hsu JT
FAU - McDonald, Douglas R
AU  - McDonald DR
FAU - Karlin, Lawrence I
AU  - Karlin LI
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - United States
TA  - Spine J
JT  - The spine journal : official journal of the North American Spine Society
JID - 101130732
RN  - 0 (FloSeal Matrix)
RN  - 0 (Hemostatics)
RN  - 9000-70-8 (Gelatin)
SB  - IM
MH  - Adolescent
MH  - Anaphylaxis/*etiology/therapy
MH  - Blood Loss, Surgical/prevention & control
MH  - Gelatin/*adverse effects
MH  - Gelatin Sponge, Absorbable/adverse effects
MH  - Hemostatics/*adverse effects
MH  - Humans
MH  - Male
MH  - Meningomyelocele/*surgery
MH  - Scoliosis/*surgery
MH  - *Spinal Fusion
EDAT- 2012/10/02 06:00
MHDA- 2013/01/03 06:00
CRDT- 2012/10/02 06:00
PHST- 2012/03/10 00:00 [received]
PHST- 2012/04/13 00:00 [revised]
PHST- 2012/08/28 00:00 [accepted]
PHST- 2012/10/02 06:00 [entrez]
PHST- 2012/10/02 06:00 [pubmed]
PHST- 2013/01/03 06:00 [medline]
AID - S1529-9430(12)00987-4 [pii]
AID - 10.1016/j.spinee.2012.08.425 [doi]
PST - ppublish
SO  - Spine J. 2012 Aug;12(8):e1-6. doi: 10.1016/j.spinee.2012.08.425.