Fatal anaphylaxis after intravenous iron dextran

This report records the first reported case of a fatal anaphylactic reaction to an intravenous infusion of iron dextran. An elderly woman was given an infusion of iron dextran in 5% dextrose. Shortly after the infusion started, she developed laryngeal stridor, shock, respiratory arrest, and died despite attempts at resuscitation. Necropsy findings are described and are consistent with death due to anaphylaxis. With the increased parenteral use of dextran and iron dextran complexes it is important for the clinician to be aware of the hazards of anaphylactic reactions. Since the reactions generally occur shortly after the administration has begun, a physician should be in attendance during the infusion of the first 25 cm3 (5 to 10 min). He should be able to promptly recognize and treat the asphyxia and hypotension should it occur. It is also important for the pathologist to be aware of the occurrence of anaphylaxis after the use of these drugs. However, the cause of death should not be based solely on the presence of classic clinical features of fatal anaphylaxis. Specific features of anaphylaxis should be searched for at autopsy and other causes of sudden death must be ruled out.