Status:
Ready to upload
Record number:
1772
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
Rare but outcome can be death. Of 42 centers surveyed, 37 were transplanting autologous bone marrow but none were presently using fetal calf serum (FCS) or other xenogeneic material during cryopreservation. Most centers, 27 of 37, used autologous plasma or serum. Of the remaining centers, 5 used human albumin, 2 used heterologous plasma, and 3 centers used other materials. Three centers had used FCS in the past in a minimum of 90 patients. None of the bone marrow transplantation programs reported any adverse reactions believed caused by anaphylaxis to bovine serum albumin (BSA) or other materials, but there were 4 other undocumented cases of sudden death during bone marrow infusion containing xenogeneic protein (personal communication).
Time to detection:
Detection occurred after infusion of <5 ml of cryopreserved autologous bone marrow. This amount of cryopreserved bone marrow in retrospect was estimated to contain < l5 mg of bovine serum albumin (BSA).
Alerting signals, symptoms, evidence of occurrence:
The patient noted warmth in his hands and feet followed shortly by the complaint of tightness in his chest. The infusion was immediately stopped, however, the patient became hypotensive, apneic, and required cardiopulmonary resuscitation.
Demonstration of imputability or root cause:
The patient’s serum was demonstrated to contain IgE antibody directed against BSA. A second aliquot of the patient’s bone marrow preparation was depleted of contaminating bovine proteins, and the patient successfully received a second transplant and was engrafted.
Imputability grade:
3 Definite/Certain/Proven
Groups audience:
Keywords:
Reference attachment:
Suggest references:
Eric Macy et al. Anaphylaxis to infusion of autologous bone marrow: An apparent reaction to self, mediated by IgE antibody to bovine serum albumin. J Allergy Clin Immunol. 1989 May;83(5):871-5