Serious complications with dextran-70 despite hapten prophylaxis. Is it best avoided prior to delivery?

Dextran is used clinically for plasma volume expansion, improvement of blood flow and thromboprophylaxis, but has been associated with untoward side effects. Immunoprophylaxis with dextran I (hapten), before the infusion of dextran-70, has reduced the incidence of serious dextran-induced anaphylactoid reactions. We report three cases of severe reactions occurring during anaesthesia in spite of immunoprophylaxis. One patient given dextran-70 before Caesarean section had a mild reaction but gave birth to a child with serious brain damage. One patient with an extremely high titre of dextran-reactive antibodies died from myocardial infarction and another patient recovered without sequelae. From our experience we conclude that dextran-induced anaphylactoid reactions are still a serious problem despite immunoprophylaxis. Dextran-70 should be avoided during pregnancy and should not be given during Caesarean section before delivery of the child. Even in the presence of immunological prophylaxis, vigilant observation of the patient is essential and resuscitation equipment must be available when starting a dextran infusion.