H KULKARNI1, L JACKSON2, K WARR3
1East Metro Health Services: Royal Perth Hospital, Perth, Australia, 2Fresenius Medical Care, Spearwood, Australia, 3South Metro Health Services: Fiona Stanley Hospital, Murdoch, Australia
Background: We report a case of anaphylactic reaction on the first dose of Mircera after conversion from darbopoetin in a long term maintenance haemodialysis patient
Case Report: 58 years male patient was established on bridging brief haemodialysis in February 2009 after removal of single kidney with large renal cell carcinoma. He was later maintained on peritoneal dialysis (until Sept 2010), home haemodialysis (till Oct 2019) and Satellite haemodialysis (till date) with progressive dilated cardiomyopathy due to chronic fluid overload. Patient was maintained on Darbopoetin from March 2009 till May 2020, with prior reported hypersensitivity reactions on first 2 doses of Erythropoetin alpha (Eprex). Details of these reactions are unlclear in records, however patient reports passing out episodes, stable blood pressure and did not require hospitalisation. A first dose of Mircera 200 mg was administered intravenously in the Satellite dialysis Unit in June 2020, with immediate periorbital oedema, rash, shortness of breath, loss of consciousness and VF arrest needing CPR, intubation and transfer to Intensive Care Unit. He was extubated after 3 days and discharged following day 15. Serum mast cell tryptase was elevated significantly, consistent with mast cell activation. A repeat test dose of darbopetin was administered under medical supervision, with no adverse reactions on stabilisation and further therapy continued at satellite unit with no adverse reactions till date. Although, serious allergic reactions, including anaphylactic reactions is reported in the product information of various ESA’s including Mircera. An experience with cross reactivity of hypersensitivity to erythropoietin alpha (Eprex) and Mircera; however with exclusion darbopetin is not prior reported.
Dr Hemant Kulkarni is a Sr Renal Physician with interest in Adult and Paeditric Nephrology including Dialysis and Transplantation; Transitional Care in Nephrology; Leadership and Policy Development; Teaching and Education; Clinical Research, and Evidence Based clinical Care.