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Contaminated Heparin: Source and Mechanism of Recent Fatal Allergic Responses & Screening Test

Henry I. Bussey, Pharm.D.
June, 2008

Reference: Kishimoto TK, Viswanathan K, Ganguly T, et.al. Contaminated heparin associated with adverse clinical events and activation of the contact system. N Engl J Med. 2008 Jun 5;358(23):2457-67. Epub 2008 Apr 23.

Oversulfated chondroitin sulfate (OSCS), which is somewhat chemically similar to heparin (a sulfated glycosaminoglycan), recently was identified as the contaminant in some batches of heparin that were found to be the source of anaphylactoid allergic reactions and death. In this report, investigators confirm the ability of this substance to activate the body's immunologic system by activating the kinin-kallikrein pathway and components of the complement system that promote anaphylaxis. In addition, the actions appeared to be linked to activation of factor XII as well. The investigators also propose a specific screening test to monitor heparin products for contamination with OSCS or other highly sulfated polysaccharide contaminants that may activate the body's allergic response systems.

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