Abstract
A 52-year-old male started a hemodialysis session. To estimate his dry weight, the percentage changes in his blood volume (%BV) were monitored using a CRIT-LINE® monitor. As he was scheduled to undergo surgery, nafamostat mesilate (NM) was used as an anticoagulant. Approximately 5 minutes after the start of the hemodialysis, he suddenly experienced a burning sensation in his shunt-side upper limb together with generalized itching. Systemic skin redness and bloodshot eyes were also observed. After 15 minutes, his %BV abruptly decreased by 16.8% but he did not develop circulatory collapse. The hemodialysis was suspended, and 100 mL of saline were infused. Then, the hemodialysis was resumed after replacing the NM with heparin. The patient’s symptoms improved. Fluid removal was continued, and his %BV had recovered to the baseline level after 1.5 hours and sharply peaked at +20% after 2 hours. A blood sample obtained during the hemodialysis session was subjected to a test for NM-specific IgE antibody, which produced a positive result. We concluded that the patient had suffered NM-induced anaphylaxis. Despite the abrupt reduction in his circulating blood volume, the patient was overhydrated at the beginning of the hemodialysis session and was not complicated by shock. In addition, he recovered rapidly from the reduction in his circulating blood volume. This might be explained by the changes in the volume and distribution of bodily fluids seen in hemodialysis patients.
