From the Guidelines
Patients with cryoglobulinemia should be cautiously evaluated before receiving CT contrast agents due to potential increased risk of adverse reactions, and alternative imaging modalities like non-contrast CT, MRI, or ultrasound should be considered when appropriate. The risk of contrast agent-induced nephropathy must be considered, especially in patients with preexisting renal insufficiency, diabetes mellitus, dehydration or volume depletion, concurrent nephrotoxic drugs, high dose of contrast agent, age greater than 70 years and cardiovascular disease 1. While there is no absolute contraindication, these patients may have a higher risk of hypersensitivity reactions and exacerbation of symptoms due to the cold nature of contrast media and their underlying immune dysregulation.
Key Considerations
- Before administering contrast, healthcare providers should ensure the patient is well-hydrated
- Renal function should be checked prior to contrast agent administration in all patients considered at risk of contrast agent nephrotoxicity 1
- Medication that interacts with intravenous contrast agent (e.g. metformin for the treatment of diabetes) and relevant medical history (e.g. compromised renal function) should be taken into consideration 1
- Pre-medication with antihistamines and corticosteroids may be considered for high-risk patients
- During administration, use the lowest effective dose of contrast and monitor the patient closely for signs of reaction including urticaria, respiratory distress, or hypotension
- Consultation with both rheumatology and radiology is advisable to determine the safest approach for individual patients.
From the Research
Risk of CT Contrast Agents in Patients with Cryoglobulinemia
- There is no direct evidence in the provided studies regarding the risk of CT contrast agents in patients with cryoglobulinemia 2, 3, 4, 5, 6.
- The studies focus on the treatment and characteristics of cryoglobulinemia, including plasma exchange, immunosuppressive therapy, and anti-viral therapy for patients with hepatitis C virus (HCV) infection 2, 3, 4, 5, 6.
- Plasma exchange is mentioned as a treatment option for cryoglobulinemia, particularly for reducing circulating cryoglobulins and alleviating symptoms 4, 6.
- However, the use of CT contrast agents is not discussed in the context of cryoglobulinemia in the provided studies.
- Therefore, there is limited information available to assess the risk of CT contrast agents in patients with cryoglobulinemia based on the provided evidence.