Suspected anaphylactic shock associated with administration of tranexamic acid in a dog

A 10-year-old male castrated Maltese was referred with clinical signs of hematuria, stranguria, and pollakiuria. The dog was diagnosed with sterile hemorrhagic cystitis with urethroliths and cystoliths. To remove the uroliths, the dog underwent retrograde urohydropropulsion followed by a cystotomy. The following day, persistent bleeding in the urinary bladder was identified with large hematoma, hematuria and anemia. In order to reduce bleeding, the dog received 10 mg/kg of tranexamic acid (TXA) intravenously. Immediately after TXA administration, the dog developed anaphylactic shock manifested by hypotension, hypothermia, tachycardia and a dull mentation. Thus, an emergency treatment including bolus injection of crystalloid, administration of dexamethasone and diphenhydramine, and oxygen supplementation was given, after which the dog quickly recovered within a few minutes.