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Tranexamic Acid: An Exceedingly Rare Cause of Anaphylaxis during Anaesthesia
R A Bansal1, A Nicholas1, A S Bansal1
1Department of Immunology and Allergy, St Helier Hospital, Carshalton, Surrey SM5 1AA, UK.
Case Reports in Immunology
|November 23, 2016
Summary
Tranexamic acid (TXA) allergy is very rare but possible. Allergy to TXA can cause anaphylaxis during anesthesia and requires skin testing for diagnosis, as blood tests are unavailable.
Area of Science:
- Anesthesiology
- Allergy and Immunology
Background:
- Anaphylaxis during anesthesia is commonly caused by neuromuscular blocking agents, opiates, and antibiotics.
- Allergic reactions to tranexamic acid (TXA) are considered extremely rare.
Purpose of the Study:
- To report a case of anaphylaxis during anesthesia attributed to tranexamic acid (TXA).
- To highlight the importance of considering TXA allergy in patients experiencing anaphylaxis during surgery.
Main Methods:
- A case report of an 80-year-old female patient who developed anaphylaxis post-intravenous TXA administration during knee replacement surgery.
- Diagnostic workup included serum tryptase measurement and allergy skin testing (skin prick and intradermal tests) with TXA and other anesthetic agents.
Main Results:
- The patient exhibited hypotension, tachycardia, and facial erythema, with elevated serum tryptase levels, consistent with anaphylaxis.
- Skin testing confirmed a positive allergic response to TXA in high dilution, while tests for other drugs were negative.
Conclusions:
- This case underscores that tranexamic acid (TXA) allergy, though rare, can occur and lead to anaphylaxis.
- Skin testing is crucial for diagnosing TXA allergy, as validated blood tests are not currently available.
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