PYROGEN REACTIONS TO HUMAN SERUM-ALBUMIN DURING PLASMA-EXCHANGE

Reactions to human serum albumin (HSA) in therapeutic plasma exchange (TPE) are rare. Nevertheless, older literature describes possible adve rse effects, including specific immune responses to albumin or other p roteins, and reactions due to contaminating organisms or pyrogen. Duri ng an eight day period three patients in our unit had unusual reaction s after infusion of 1.5-2 L of HSA. Patient 1 had trembling that persi sted for 20 min. Patient 2 had shaking for 40 min despite calcium gluc onate infusion, and fever to 100.8 degrees F. Patient 3 had severe rig ors that subsided after 90 min when meperidine was finally given, and fever to 103.5 degrees F. Record reviews revealed that all three patie nts had received HSA from the same lot, and that only one other TPE pa tient had received HSA from that lot. Neither our pharmacy nor the man ufacturer was aware of other reactions associated with that lot. Mater ial from a bottle only partially infused to patient 3 was negative in culture and was negative far pyrogen when retested by the manufacturer . Nevertheless, because patients 1 and 2 had each had multiple previou s uneventful TPEs and because all three patients tolerated subsequent TPEs without incident when another brand of HSA was used, we conclude that these patients had pyrogen reactions to the implicated HSA lot. T his experience illustrates the value of cluster recognition in arousin g suspicion of unusual reactions to HSA and the value of recorded lot numbers in pursuing such suspicions. Apheresis personnel should be awa re of the potential for pyrogen reactions with HSA and should record l ot numbers of all fluids infused during TPE. (C) 1995 Wiley-Liss, Inc.