Signs and symptoms
Signs and symptoms of reactions to DMSO include:rr
- nausea and vomiting
- hypotension
- hypertension
- headache
- bradycardia
- back and/or abdominal pain
- skin rash
- tightness in the throat
- alterations of heart rate
- dyspnoea and/or hypoxia
- chest pain/discomfort
- dizziness and/or seizures
- flushing and/or itching of the skin.
The following serious adverse events have been reported in literature:r
- encephalopathy
- cardiac arrest
- respiratory depression
- alveolar haemorrhage
- reversible encephalopathy
- fatal cardiac arrhythmia
- leukoencephalopathy
- cerebral infarction
- severe respiratory arrest
- epileptic seizure
- severe neurotoxicity
- sustained encephalopathy
- paradoxical embolism
- cerebral infarction
- coronary spasm
- neurotoxicity
- neural depression
- transient global amnesia
- severe neurotoxicity
- induced toxicities
- transient consciousness loss.
The vast majority of cardiac side effects are self-limiting and are not usually associated with serious morbidity and mortality.
Investigations and diagnosis
Both anaphylaxis and infusion reactions are serious, and patients should be closely monitored throughout and following the infusion, as per local policy.
Perform baseline clinical observations, including:
- blood pressure
- temperature
- heart rate, NB: pulse rate must be monitored manually to detect any irregularity or changes in rhythm
- oxygen saturation
- respiration rate.
Repeat observations every 15 minutes during HSC infusion.
Clinical observations should be attended at infusion completion and monitored every two (2) hours for the next 6 hours and then four (4) hourly for the next 24 hours.
The staff member responsible for the infusion of HSC product must remain at the patient's bedside until the procedure is completed. Increased frequency in patient observations monitoring will be required when the patient has an unstable underlying condition, becomes unwell or shows signs of a transfusion reaction.
Grading
Grade |
Allergic reaction |
1 |
Systemic intervention not indicated |
2 |
Oral intervention indicated |
3 |
Bronchospasm; hospitalisation indicated for clinical sequelae; intravenous intervention indicated |
4 |
Life-threatening consequences; urgent intervention indicated |
5 |
Death |
Common Terminology Criteria for Adverse Events (CTCAE) v5.0, November 27, 2017
Grade |
Anaphylaxis |
1 |
- |
2 |
- |
3 |
Symptomatic bronchospasm, with or without urticaria; parenteral intervention indicated; allergy related oedema/angioedema; hypotension |
4 |
Life-threatening consequences; urgent intervention indicated |
5 |
Death |
Common Terminology Criteria for Adverse Events (CTCAE) v5.0, November 27, 2017
While use of these separate grading scales may be useful for classifying the nature of an infusion reaction for research purposes, they are less useful for clinical care since it may not be obvious if the patient is having an infusion reaction or an allergic reaction.