Haemofiltration and Noradrenaline Corrects life-Threatening Cardiovascular Instability Following Delayed Anaphylactic Reaction to Patent Blue Dye in Sentinel Node Biopsy for Breast Cancer

Peter K. Donnelly¹, Louise Robinson², Matt Halkes², Andy Goodman³

¹Department of Breast Surgery, Torbay Hospital, South Devon Healthcare NHS Foundation Trust, Torquay, UK.
²Department of Anaesthesia, Torbay Hospital, South Devon Healthcare NHS Foundation Trust, Torquay, UK.
³Department of Oncology, Torbay Hospital, South Devon Healthcare NHS Foundation Trust, Torquay, UK.

DOI: 10.4236/jct.2014.512111                

Abstract

The aim of this case report is to present a novel approach to the management of very severe anaphylactic reaction to Patent Blue Dye used in Sentinel Node Biopsy for breast cancer treatment. The severity and duration of cardiovascular effects has not been described previously in this setting. Comprehensive ICU support including heamofiltration resulted in the patients’ complete recovery and successful long-term well-being despite a change to our routine cancer care plan.

Keywords

Blue Dye, Anaphylaxis, Sentinel Node, Haemofiltration, Breast Cancer

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	National Institute for Health and Clinical Excellence Guideline (2009) Breast Cancer (Early & Locally Advanced): Diagnosis and Treatment. http://www.nice.org.uk/CG80
[2]	Keshtgar, M., Aresti, N. and MacNeil, F (2010) Establishing Axillary Sentinel Node Biopsy SLNB for Early Breast Cancer in the United Kingdom. A Survey of National Training Program. European Journal of Surgical Oncology, 36, 393-398.
[3]	Mansel, R.E., Goyal, A., Fallowfield, L. and Newcombe, R.G. (2006) Randomised Multicenter Trial of Sentinel Node Biopsy versus Standard Axillary Treatment in Operable Breast Cancer: The ALMANAC trial. Journal of the National Cancer Institute, 98, 599-609. http://dx.doi.org/10.1093/jnci/djj158
[4]	Barthelmes, L., Goyal, A., Newcombe, R.G., McNeill, F. and Mansel, R.E. (2010) Adverse Reactions to Patent Blue V Dye—The NEW START and ALMANAC Experience. European Journal of Surgical Oncology, 36, 399-403.
[5]	White, V., Harvey, J.R. and Griffith, C.D.M. (2011) Youssef, Carr MSentinel Node Biopsy in Early Breast Cancer Surgery—Working with the Risks of Vital Blue Dye to Reap the Benefits. European Journal of Surgical Oncology, 37, 101-108.
[6]	Quincey, N., Jones, C. and Kissin, M. (2012) Anaphylaxis to Dye during Breast Surgery. Anaesthesia, 67, 80.
[7]	Masamat, Y., Shenoy, H., Spiers, V., Hanby, A. and Horgan, K. (2006) Properties and Characteristics of the Dyes Injected to Assist Axillary Sentinel Node Localization in Breast Surgery. European Journal of Surgical Oncology, 32, 381-384.
[8]	Laxenaire, M.C. and Mertes, P.M. (2001) Anaphylaxis during Anaesthesia. Results of a Two-Year Survey in France. British Journal of Anaesthesia, 87, 549-558. http://dx.doi.org/10.1093/bja/87.4.549
[9]	Hunting, A.S., Nopp, A., Johansson, S.G.O.F., Wilhelmsen, V. and Guttormsen, A.B. (2010) Anaphylaxis to Patent Blue VI Clinical Aspects. Allergy, 45, 117-123.
[10]	Lucas, N., Intern, S.B., Laine, P., Nicolie, B. and Fondriner, E. (2010) Anaphylactic Shock Due to Patent Blue; Four Case Report and Review of the Literature. Journal de Gynécologie Obstétrique et Biologie de la Reproduction, 39, 116-120. http://dx.doi.org/10.1016/j.jgyn.2009.10.006
[11]	Stark, B.J. and Sullivan, T.J. (1986) Biphasic and Protracted Anaphylaxis. Journal of Allergy and Clinical Immunology, 78, 76. http://dx.doi.org/10.1016/0091-6749(86)90117-X
[12]	Lantis, S., Filippakis, G. and Hadjiminas, D.J. (2008) Atypical Anaphylactic Reaction to Patent Blue Dye during Sentinel lymph Node Biopsy for Breast Cancer. Annals of the Royal College of Surgeons of England, 90, 338-339.
[13]	MHRA Drug Safety Notice 2012. Safety Information on the Use of Blue Dye Patent Blue V. UK National Pharmacovigilence Expert Advisory Group of the Commission on Human Medicines.
[14]	Van der Vorst, J.R., Schaafsma, B.E., Verbeek, F.P., Hutteman, M., Mieog, J.S.D., Lowik, C.W.G.M., Liefers, G.J., Frangioni, J.V., van de Velde, C.J.H. and Vahrmeiger A.L. (2012) Randomised Comparison of Near-Infrared Fluorescence Imaging Using Indocyanine Green and 99m Technetium with or without Patent Blue Dye for the Sentinel Lymph Node Procedure in Breast Cancer Patients. Annals of Surgical Oncology, 19, 4104-4111. http://dx.doi.org/10.1245/s10434-012-2466-4
[15]	Douek, M., Klasse, J., Monypenny, I., Kothari, A., Zechmeister, K., Brown, D., Wyld, L., Drew, P., Garmo, H., Agbaje, O., Pankhurst, Q., Anning, B., Grootendorst, M., Ten Haken, B., Hall-Creggs, M.A., Purushotham, A. and Pinder, S. (2014) Sentinel Node Biopsy Using a Magnetic Tracer versus Standard Technique: The SentiMAG Multicentre Trial. Annals of Surgical Oncology, 21, 1237-1245.