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November 4, 1983, Vol 250, No. 17 >
ARTICLE | November 4, 1983

Fatal Complement-Induced Leukostasis After Diatrizoate Injection: Title and subTitle BreakPrinciples of Clinicopathologic Diagnosis FREE

Henry Schneiderman, MD; Dale E. Hammerschmidt, MD; Anne Ritke McCall; Harry S. Jacob, MD
[+] Author Affiliations

Reprint requests to the Department of Medicine, University of Connecticut Health Center, Room L-3092, Farmington, CT 06032 (Dr Schneiderman).


JAMA. 1983;250(17):2340-2342. doi:10.1001/jama.1983.03340170066031
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References

A case of fatal radiographic contrast medium (RCM)-induced pulmonary granulocyte aggregation (leukostasis) showed massive elevation of the postmortem histamine level. Suspicion of this phenomenon in diverse clinical settings permits clinical and pathological documentation via increased plasma levels of C3a and other means. The existence of effective prophylaxis stimulates a search for predictive tests.

(JAMA 1983;250:2340-2342)

REFERENCES

1 +
Jacob HS, Craddock PR, Hammerschmidt DE, et al:  Complement-induced granulocyte aggregation: An unsuspected mechanism of disease . N Engl J Med 1980;;302:789-794.
2 +
Chenoweth DE, Cooper SW, Hugli TE, et al:  Complement activation during cardiopulmonary bypass: Evidence for generation of C3a and C5a anaphylatoxins . N Engl J Med 1981;;304:497-502.
3 +
Winston DJ, Ho WG, Gale RP:  Prophylactic granulocyte transfusions during chemotherapy of acute nonlymphocytic leukemia . Ann Intern Med 1981;;94:616-622.
4 +
Boxer LA, Ingraham LM, Allen J, et al:  Amphotericin-B promotes leukocyte aggregation of nylon-wool-fiber-treated polymorphonuclear leukocytes . Blood 1981;;58:518-523.
5 +
Cogen FC, Norman ME, Dunsky E, et al:  Histamine release and complement changes following injection of contrast media in humans . J Allergy Clin Immunol 1979;;64:299-303.
6 +
Arroyave CM, Bhat KN, Crown R:  Activation of the alternative pathway of the complement system by radiographie contrast media . J Immunol 1976;;117:1866-1869.
7 +
Arroyave CM, Tan EM:  Activation of the alternative pathway of complement by radiographic contrast medium: In vivo and in vitro studies , in Opferkuch W, Rother K, Schultz DR (eds): Clinical Aspects of the Complement System . Stuttgart, West Germany, Georg Thieme, Verlag, 1978;, pp 168-172.
8 +
Lasser EC, Sovak M, Lang JH:  Development of contrast medium idiosyncrasy in the dog . Radiology 1976;;119:91-95.
9 +
Bhat KN, Arroyave CM, Crown R:  Reaction to radiographic contrast agents: New developments in etiology . Ann Allergy 1976;;37:169-173.
10 +
Lasser EC, Kolb WF, Lang JH:  Contrast media activation of serum complement system , abstracted. Invest Radiol 1974;;9:6.
11 +
Till G, Papke-Hesse C, Rother U, et al:  Activation of serum complement by x-ray contrast media , in Opferkuch W, Rother K, Schultz DR (eds): Clinical Aspects of the Complement System . Stuttgart, West Germany, Georg Theime, Verlag, 1978;, pp 162-166.
12 +
Austen KF:  Systemic anaphylaxis in the human being . N Engl J Med 1974;;291:661-664.
13 +
Lie JT, Holley KE, Kampa WR, et al:  New histochemical method for morphologic diagnosis of early stages of myocardial ischemia . Mayo Clin Proc 1971;;46:319-327.
14 +
Doyle JT:  Mechanisms and prevention of sudden death . Mod Concepts Cardiovasc Dis 1976;;45:111-116.
15 +
Lundberg GD, Voigt GE:  Reliability of a presumptive diagnosis of sudden unexpected death in adults: The case for autopsy . JAMA 1979;;242:2328-2330.
16 +
Sussman ML, Neroman A: Urologic Radiology , ed 2. Baltimore, Williams & Wilkins Co, 1976;, pp 6-9.
17 +
Witten DM:  Reactions to urographic contrast media . JAMA 1975;;231:974-977.
18 +
Ring J, Simon RA, Arroyave CM:  Increased in vitro histamine release by radiographic contrast media in patients with history of incompatibility . Clin Exp Immunol 1978;; 34:302-309.
19 +
Hammerschmidt DE, White JG, Craddock PR, et al:  Corticosteroids inhibit complementinduced granulocyte aggregation . J Clin Invest 1979;;63:798-803.
20 +
Zweiman B, Mishkin MM, Hildreth EA:  An approach to the performance of contrast studies in contrast material-reactive persons . Ann Intern Med 1975;;83:159-162.
21 +
Craddock PR, Hammerschmidt D, White JG, et al:  Complement (C5a)-induced granulocyte aggregation in vitro: A possible mechanism of complement-mediated leukostasis and leukopenia . J Clin Invest 1977;;60:260-264.
22 +
Hammerschmidt DE, Bowers TK, Lammi-Keefe CJ, et al:  Granulocyte aggregometry: A sensitive technique for the detection of C5a and complement activation . Blood 1980;;55:898-902.
23 +
Lalli AF:  Contrast media reactions: Data analysis and hypothesis . Radiology 1980;;134:1-12.
24 +
Greganti MA, Flowers WM Jr:  Acute pulmonary edema after the intravenous administration of contrast media . Radiology 1979;; 132:583-585.
25 +
Hammerschmidt DE, Harris PD, Wayland H, et al:  Complement-mediated granulocyte aggregation in vivo . Am J Pathol 1981;;102:146-150.
26 +
Hammerschmidt DE, Weaver LJ, Hudson LD, et al:  Association of complement activation and elevated plasma-C5a with adult respiratory distress syndrome . Lancet 1980;;1:947-949.
27 +
Weisdorf DJ, Hammerschmidt DE, Jacob HS, et al:  Rapid in vivo clearance of C5a(desarg): A protective mechanism against complement-mediated tissue injury . J Lab Clin Med 1981;; 98:823-830.
28 +
Craddock PR, Fehr J, Brigham KL, Kronenberg RS, et al:  Complement and leukocytemediated pulmonary dysfunction in hemodialysis . N Engl J Med 1977;;296:769-774.
29 +
Haynes RC Jr, Murad F:  Adrenocortical steroids , in Gilman AG, Goodman LS, Gilman A (eds): The Pharmacologic Basis of Therapeutics , ed 6. New York, MacMillan Publishing Co Inc, 1980;, pp 1470-1492.

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1 +
Jacob HS, Craddock PR, Hammerschmidt DE, et al:  Complement-induced granulocyte aggregation: An unsuspected mechanism of disease . N Engl J Med 1980;;302:789-794.
2 +
Chenoweth DE, Cooper SW, Hugli TE, et al:  Complement activation during cardiopulmonary bypass: Evidence for generation of C3a and C5a anaphylatoxins . N Engl J Med 1981;;304:497-502.
3 +
Winston DJ, Ho WG, Gale RP:  Prophylactic granulocyte transfusions during chemotherapy of acute nonlymphocytic leukemia . Ann Intern Med 1981;;94:616-622.
4 +
Boxer LA, Ingraham LM, Allen J, et al:  Amphotericin-B promotes leukocyte aggregation of nylon-wool-fiber-treated polymorphonuclear leukocytes . Blood 1981;;58:518-523.
5 +
Cogen FC, Norman ME, Dunsky E, et al:  Histamine release and complement changes following injection of contrast media in humans . J Allergy Clin Immunol 1979;;64:299-303.
6 +
Arroyave CM, Bhat KN, Crown R:  Activation of the alternative pathway of the complement system by radiographie contrast media . J Immunol 1976;;117:1866-1869.
7 +
Arroyave CM, Tan EM:  Activation of the alternative pathway of complement by radiographic contrast medium: In vivo and in vitro studies , in Opferkuch W, Rother K, Schultz DR (eds): Clinical Aspects of the Complement System . Stuttgart, West Germany, Georg Thieme, Verlag, 1978;, pp 168-172.
8 +
Lasser EC, Sovak M, Lang JH:  Development of contrast medium idiosyncrasy in the dog . Radiology 1976;;119:91-95.
9 +
Bhat KN, Arroyave CM, Crown R:  Reaction to radiographic contrast agents: New developments in etiology . Ann Allergy 1976;;37:169-173.
10 +
Lasser EC, Kolb WF, Lang JH:  Contrast media activation of serum complement system , abstracted. Invest Radiol 1974;;9:6.
11 +
Till G, Papke-Hesse C, Rother U, et al:  Activation of serum complement by x-ray contrast media , in Opferkuch W, Rother K, Schultz DR (eds): Clinical Aspects of the Complement System . Stuttgart, West Germany, Georg Theime, Verlag, 1978;, pp 162-166.
12 +
Austen KF:  Systemic anaphylaxis in the human being . N Engl J Med 1974;;291:661-664.
13 +
Lie JT, Holley KE, Kampa WR, et al:  New histochemical method for morphologic diagnosis of early stages of myocardial ischemia . Mayo Clin Proc 1971;;46:319-327.
14 +
Doyle JT:  Mechanisms and prevention of sudden death . Mod Concepts Cardiovasc Dis 1976;;45:111-116.
15 +
Lundberg GD, Voigt GE:  Reliability of a presumptive diagnosis of sudden unexpected death in adults: The case for autopsy . JAMA 1979;;242:2328-2330.
16 +
Sussman ML, Neroman A: Urologic Radiology , ed 2. Baltimore, Williams & Wilkins Co, 1976;, pp 6-9.
17 +
Witten DM:  Reactions to urographic contrast media . JAMA 1975;;231:974-977.
18 +
Ring J, Simon RA, Arroyave CM:  Increased in vitro histamine release by radiographic contrast media in patients with history of incompatibility . Clin Exp Immunol 1978;; 34:302-309.
19 +
Hammerschmidt DE, White JG, Craddock PR, et al:  Corticosteroids inhibit complementinduced granulocyte aggregation . J Clin Invest 1979;;63:798-803.
20 +
Zweiman B, Mishkin MM, Hildreth EA:  An approach to the performance of contrast studies in contrast material-reactive persons . Ann Intern Med 1975;;83:159-162.
21 +
Craddock PR, Hammerschmidt D, White JG, et al:  Complement (C5a)-induced granulocyte aggregation in vitro: A possible mechanism of complement-mediated leukostasis and leukopenia . J Clin Invest 1977;;60:260-264.
22 +
Hammerschmidt DE, Bowers TK, Lammi-Keefe CJ, et al:  Granulocyte aggregometry: A sensitive technique for the detection of C5a and complement activation . Blood 1980;;55:898-902.
23 +
Lalli AF:  Contrast media reactions: Data analysis and hypothesis . Radiology 1980;;134:1-12.
24 +
Greganti MA, Flowers WM Jr:  Acute pulmonary edema after the intravenous administration of contrast media . Radiology 1979;; 132:583-585.
25 +
Hammerschmidt DE, Harris PD, Wayland H, et al:  Complement-mediated granulocyte aggregation in vivo . Am J Pathol 1981;;102:146-150.
26 +
Hammerschmidt DE, Weaver LJ, Hudson LD, et al:  Association of complement activation and elevated plasma-C5a with adult respiratory distress syndrome . Lancet 1980;;1:947-949.
27 +
Weisdorf DJ, Hammerschmidt DE, Jacob HS, et al:  Rapid in vivo clearance of C5a(desarg): A protective mechanism against complement-mediated tissue injury . J Lab Clin Med 1981;; 98:823-830.
28 +
Craddock PR, Fehr J, Brigham KL, Kronenberg RS, et al:  Complement and leukocytemediated pulmonary dysfunction in hemodialysis . N Engl J Med 1977;;296:769-774.
29 +
Haynes RC Jr, Murad F:  Adrenocortical steroids , in Gilman AG, Goodman LS, Gilman A (eds): The Pharmacologic Basis of Therapeutics , ed 6. New York, MacMillan Publishing Co Inc, 1980;, pp 1470-1492.

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