Thursday July 05, 2007
Increased risk of severe protamine reactions in NPH dependent diabetics and with fish allergy


Protamine is a commonly used reversal for systemic heparinization after cardiac procedures. Protamine is well known for its relatively rare but severe anaphylaxis.

Patients using NPH are more prone to such reactions and caution should be exercise in such patients. Because NPH as stands for Neutral Protamine Hagedorn contains protamine, it is suspected that NPH insulin-dependent diabetic patients would develop sensitivity to protamine 1.

Similarly, people allergic to fish are also prone to protamine reaction as afterall protamine comes from sperm of salmon fish ! 2

Beside standard preacution (giving diluted and slowly) and treatment of anaphylaxis, methylene blue has been proposed as the treatment of protamine reaction 3.




References: click to get abstracts/articles

1. Increased risk of severe protamine reactions in NPH insulin-dependent diabetics undergoing cardiac catheterization, Circulation, Vol 70, 788-792

2. PHYSICAL AND CHEMICAL PROPERTIES OF PROTAMINE FROM THE SPERM OF SALMON (ONCORHYNCHUS TSCHAWYTSCHA) - Paper originally published in 1957, source - Journal of Biological Chemistry

3. Catastrophic Cardiovascular Adverse Reactions to Protamine Are Nitric Oxide/Cyclic Guanosine Monophosphate Dependent and Endothelium Mediated Should Methylene Blue Be the Treatment of Choice? - Chest. 2002;122:1061-1066.