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LETTER TO THE EDITOR  
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Allergic reaction to heparin gel – Adding agony to blood donor


 Department of Transfusion Medicine, Dr. Rela Institute and Medical Centre, Bharat Institute of Higher Education and Research, Chennai, Tamil Nadu, India

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Date of Submission06-Sep-2021
Date of Decision13-Apr-2022
Date of Acceptance14-May-2022
Date of Web Publication26-Sep-2022
 


How to cite this URL:
Sachan D, Gundrajukuppam DK, Priyadarshini K. Allergic reaction to heparin gel – Adding agony to blood donor. Asian J Transfus Sci [Epub ahead of print] [cited 2022 Dec 4]. Available from: https://www.ajts.org/preprintarticle.asp?id=356858


Sir,

Blood donation is a safe procedure yet the incidence of some adverse reactions is inevitable. Incidence of localized donor adverse reactions is approximately 7%–8% which include hematoma (bruise), delayed bleeding, arterial puncture, nerve injury or pain in arm, and localized infection.[1] Local allergic reactions are reported approximately 4 in 1000 in blood and platelet donors and may be presented as redness or irritation at the site of venipuncture.[1] As defined in (Hemovigilance Programme of India [HvPI]), these reactions are caused by allergens in arm disinfectants such as iodine or chlorhexidine or due to the application of the adhesive bandage.[1],[2]

We recently encountered two allergic reactions due to Thrombophob (heparin gel) ointment in our blood center in March and June 2021, respectively. First case, a whole blood donor reported 48 h after the blood donation with skin discoloration due to superficial hematoma. The donor was counseled, and also, the ointment was locally applied. The donor developed a reddish discoloration and burning sensation in applied area immediately on application [Figure 1]. Second case, a plateletpheresis donor who had a superficial hematoma (2 cm × 2 cm), and on Thrombophob application, further developed a 3 cm × 4 cm urticarial rash on the site of ointment application [Figure 2]. In both the cases, the ointment was cleaned from application site and the donors were given oral antihistamines and they recovered within 2 h. There were no systemic symptoms in the form of respiratory symptoms, hypotension, etc. The ointment Thrombophob was regularly used for donors with hematoma and was of two different LOT (I002871 and I004767) in both occasions and was within date of expiry (2023).
Figure 1: Erythematous reaction of the skin on thrombophob application area

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Figure 2: Urticarial reaction at the site of thrombophob application

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For superficial hematomas, the blood bank routinely uses Thrombophob ointment as per NACO recommendation for hematoma management.[3] Thrombophob is the trade name of gel of heparin and benzyl nicotinate and is used in subcutaneous hematomas, superficial thrombophlebitis, localized infiltrates and edemas, traumas, and injuries.[4] Heparin is a sulfated glycosaminoglycan with anticoagulant properties which inhibits thrombin formation, promotes fibrinolysis, and helps in the absorption of the more superficial microthrombi. Benzyl nicotinate enhances local heparin absorption by vasodilatation. Cutaneous allergic reactions due to subcutaneously injected heparin have been reported before (not unusual); however, the contact dermatitis from topical heparin in blood donors so far is uncommon.[5]

This illustration is to bring forth a notice of such localized reactions due to Thrombophob/heparin gel which adds further agony of blood donor by second or third adverse reaction in addition to hematoma. Such reactions can be added to the list of causes that can produce allergic reaction in blood donors under HvPI and also the preventive and corrective action should be further studied and recommended in the form of history of allergy taking, patch test, medications, or alternative ointments for blood bank purposes.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Bisht A, Marwaha N, Arora S, Patidar GK, Chhabra R. National blood donor vigilance programme of India: Analysis of donor adverse reactions reported during initial 2 years of implementation (2016 and 2017). Asian J Transfus Sci 2021;15:1-11.  Back to cited text no. 1
  [Full text]  
2.
Dhawan HK, Arora S, Sachdev S, Sharma RR, Marwaha N. Allergic contact dermatitis to antiseptic medicated dressing applied on phlebotomy site. Asian J Transfus Sci 2010;4:133.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
NACO Guidelines on Blood Donor Selection in Training Module for Blood Bank Nurses; 2015. Available from: http://www.naco.gov.in/sites/default/files/3Training%20Module%20For%20Blood%20Bank%20Nurses_split_1.pdf. [Last accessed on 2021 Nov 06].  Back to cited text no. 3
    
4.
Saini B, Paul P. Effectiveness of cold application, heparinoid application and magnesium sulphate application on superficial thrombophlebitis among patients. Ind J N Stud 2011;2:4-10.  Back to cited text no. 4
    
5.
Basavarajegowda A, Anand D, Krishnappa P. Contact urticaria to thrombophob gel. Glob J Transfus Med 2021;6:115-6.  Back to cited text no. 5
  [Full text]  

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Correspondence Address:
Deepti Sachan,
Department of Transfusion Medicine, Dr. Rela Institute and Medical Centre, Bharat Institute of Higher Education and Research, Chennai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ajts.ajts_131_21



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2006 - Asian Journal of Transfusion Science | Published by Wolters Kluwer - Medknow
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