2013 Volume 4 Issue 2 Pages 168-171
The symptoms of nafamostat masilate (NM) hypersensitivity are diverse and range from minor ones such as chills to severe ones such as shock. Although discontinuation of NM is considered when minor symptoms of NM hypersensitivity appear, NM is sometimes used with careful observation because of concerns regarding the exacerbation of bleeding tendency due to changes in heparin. At present, it is impossible to diagnose as NM hypersensitivity at the bedside. A non-invasive continuous hematocrit monitor has been widely used as a method to detect blood volume variations (ΔBV) during hemodialysis. We experienced one case who was presumptively diagnosed with NM hypersensitivity, in whom ΔBV showed paradoxical variations that were unrelated with water removal. A 73-year-old man with end-stage of renal disease started hemodialysis 7 years ago. He had used NM at the initiation of dialysis. He was admitted to our hospital, because of intractable pleural effusion. The anticoagulant was changed in NM from heparin because of the presence of bloody plural effusion. During every dialysis therapy using NM, an acute and atypical change in ΔBV was observed with the emergence of chills and trepidation approximately 60 minutes after the start of dialysis. When the anticoagulant was changed in heparin, these symptoms and change in ΔBV were not observed. Subsequently, the patient was diagnosed as being positive for NM specific IgE antibodies.
