Fibrinolysis during anaphylaxis, and its spontaneous resolution, as demonstrated by thromboelastography.
A large and ever-growing number of agents used in anaesthesia can precipitate acute anaphylactic reactions after their administration. Anaphylaxis is a sudden onset (or rapidly progressive), severe systemic allergic reaction, affecting multiple organ systems. The number of people who suffer severe systemic allergic reactions is increasing. The incidence is about 1-3 reactions per 10 000 population per annum, although anaphylaxis is not always recognized; therefore, certain UK studies may underestimate the incidence. In this case report, we present an episode of acute fibrinolysis associated with life-threatening anaphylaxis, demonstrated by thromboelastography (TEG) and resolving spontaneously. This is despite an added fibrinolytic insult in the form of cardiopulmonary bypass. There is a paucity of literature detailing fibrinolysis occurring during anaphylaxis, most likely due to the limited availability of TEG in the acute setting and the primary clinical focus of delivering life-saving interventions.
Iqbal
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A
Featherstone Department of Anaesthesia and Intensive Care, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK. docasimiqbal@msn.com
Morton
C
C
Kong
K-L
KL
D000368:Aged; D000707:Anaphylaxis / Q000097:blood* / Q000139:chemically induced / Q000175:diagnosis; D018681:Anesthetics, General / Q000009:adverse effects; D001026:Coronary Artery Bypass; D005342:Fibrinolysis; D006801:Humans; D007431:Intraoperative Complications / Q000097:blood* / Q000175:diagnosis; D008297:Male; D008943:Mitral Valve / Q000601:surgery; D013916:Thrombelastography
D018681:Anesthetics, General