Tryptase negative Anaphylaxis, an interesting case in the context of major obstetric
haemorrhage
Abstract:
Anaphylaxis during pregnancy, labour and delivery can be catastrophic for the mother and
baby. During the first three trimesters, aetiologies are similar to those in non-pregnant
women. During labour and delivery, common aetiologies are beta-lactam antibiotics, latex,
and other agents used in medical and peri-operative settings, including less commonly blood
products. Anaphylactic transfusion reactions are more frequent with components containing
a high volume of plasma. In most cases, the exact cause is unknown.
We report a case of a 35 year old lady who had her 4th caesarean section for a twin
pregnancy. She had a combined spinal and epidural (CSE) and after a 1.7L blood loss intraoperatively was taken to recovery for monitoring. The patient continued to bleed in
recovery where she was resuscitated. During resuscitation, she developed an anaphylactic
reaction. The anaphylaxis was dealt with, but ongoing bleeding meant the patient had to
return to theatre. She had a hysterectomy and later required uterine artery embolisation.
The patient returned to theatre on two further occasions due to persistent bleeding. In this
case report, we discuss anaphylaxis in the context of major obstetric haemorrhage. The
cause of anaphylaxis remained undetected and the tryptase levels were within normal
limits.