Hypersensitivity dextrans

Iron salts occasionally cause gastrointestinal irritation, nausea, vomiting, constipation, diarrhea, headache, backache, and allergic reactions. The stools usually appear darker (black). Iron dextran is given by the parenteral route Hypersensitivity reactions, including fatal anaphylactic reactions, have been reported with the use of this form of iron. Additional adverse reactions include soreness, inflammation, and sterile abscesses at the intramuscular (IM) injection site Intravenous (IV) administration may result in phlebitis at the injection site When iron is administered via the IM route, a brownish discoloration of tlie skin may occur. Fhtients with rheumatoid arthritis may experience an acute exacerbation of joint pain, and swelling may occur when iron dextran is administered. 

Monitoring and Managing Adverse Reactions When tiie patient is receiving iron dextran, the nurse monitors closely for a hypersensitivity reaction. Epinephrine is kept on standby in tiie event of severe anaphylactic reaction. 

Hypersensitivity reactions Anaphylaxis and other hypersensitivity reactions have been reported after uneventful test doses as well as therapeutic doses of iron dextran injection. Therefore, consider administration of subsequent test doses during therapy. Have epinephrine immediately available in the event of acute hypersensitivity reactions. 

Contraindications Active internal bleeding, arteriovenous malformation or aneurysm, cerebrovascular accident (CVA) with residual neurologic defect, history of CVA (within the past 2 yr) or oral anticoagulant use within the past 7 days unless PT is less than 1.2 X control, history of vasculitis, hypersensitivity to murine proteins, intracranial neoplasm, prior IV dextran use before or during percutaneous transluminal coronary angioplasty (PTCA), recent surgery or trauma (within the past 6 wk), recent (within the past 6 wk or less) GI or GU bleeding, thrombocytopenia (less than 100,000 cells/pl), and severe uncontrolled hypertension... 

Sodium ferric gluconate complex and iron-sucrose complex are alternative parenteral iron preparations. These agents can be given only by the intravenous route. They appear to be less likely than high-molecular-weight iron dextran to cause hypersensitivity reactions. 

Iron dextran, iron sucrose complex, and sodium ferric gluconate complex Parenteral preparations can cause hypersensitivity reactions ... 

Owing to the risk of a hypersensitivity reaction, a small test dose of iron dextran should always be given before full intramuscular or intravenous doses are given. Patients with a strong history of allergy and patients who have previously received parenteral iron are more likely to have hypersensitivity reactions following treatment with parenteral iron dextran. 

After intramuscular iron dextran, symmetrical allergic purpura of the lower limbs due to hypersensitivity vasculitis has been observed in a child (41). 

Innnunologic Dextran 70 has been used as stabilizer in a measles-mumps-rubella (MMR) vaccine product named Morupar. This vaccine was associated with dextran-driven hypersensitivity reactions with high concentrations of dextran-spedfic IgG [43"]. The most probable mechanism is immune complex-mediated reactions caused by naturally occurring dextran-specific antibodies. Morupar was withdrawn from the market. 

Zanoni G, Puccetti A, Dolcino M, Simone R, Peretti A, Ferro A, Tridente G. Dextran-specific IgG response in hypersensitivity reactions to measles-mumps-rubella vaccine. J Allergy Clin Immunol 2008 122(6) 1233-5. 

The role of Dextran 40 (= low molecular weight dextran) in inducing acute renal failure has been reviewed (27), and its mechanism discussed. The recently reported acute glomerulonephritis appears to be mediated through a hypersensitivity phenomenon. Osmotic nephropathy is a well-known complication of dextran infusion. In dehydrated states Dextran 40 is concentrated in the proximal tubules, producing a viscid fluid which can cause tubular obstruction. 

An allergic hypersensitivity reaction -generalized itching, erythema and oedema of the eyelids — occurred with Dextran 70 during hysteroscopy for removal of an implanted Daikon shield. No previous exposure to dextran was known to the patient. Dextran was given to prevent anticipated bleeding (34 ). 

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