• Clin Med (Lond) · Nov 2024

    Case Reports

    Thromboelastography for Rapid Diagnosis of Heparin-Like Anticoagulant Release During Anaphylaxis-Induced Coagulopathy in Systemic Mastocytosis: A Case Report.

    • Rajkumar Rajendram, Abdul Hadi Al-Qahtani, and Farrukh Sheikh.
    • Department of Acute General Medicine, John Radcliffe Hospital, Oxford University Hospitals, Oxford, United Kingdom; Medical Protocol Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia; Department of Medical Education, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia. Electronic address: rajkumarrajendram@doctors.org.uk.
    • Clin Med (Lond). 2024 Nov 17; 25 (1): 100267100267.

    AbstractAnaphylaxis can induce life-threatening coagulopathy by releasing various mediators from activated mast cells. These mediators directly affect coagulation and fibrinolytic pathways, increasing the bleeding risk. Diagnosis and management of anaphylaxis-induced coagulopathy remain challenging. We report a unique case of a 44-year-old man with undiagnosed systemic mastocytosis who developed peanut-induced anaphylactic shock, resulting in cardiac arrest. Laboratory tests revealed elevated serum tryptase and severe coagulopathy. Thromboelastography, a point-of-care viscoelastic monitoring (VEM) test identified the presence of heparin-like anticoagulants within minutes. Bone marrow examination subsequently confirmed isolated mastocytosis. This case highlights the potential of VEM for rapid diagnosis and management of coagulopathy in patients with anaphylaxis, potentially aiding in the identification of mast cell degranulation in undifferentiated shock. We suggest that VEM should be considered in the investigation of patients with suspected anaphylaxis-induced coagulopathy.Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.

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