Fatal anaphylactic reaction to iron sucrose in pregnancy
A 20 years-old primigravida with seven months amenorrhea presented to the emergency department with giddiness and difficulty in breathing. The history of presenting complaints revealed that she had developed these complaints within few minutes of receiving first infusion of iron sucrose USP 5 ml injection (FERISE 5 brand of Intas Pharma Company) diluted in 100 ml normal saline for severe iron deficiency anemia in a primary health care centre.Parenteral iron therapy was initiated to her because she was noncompliant to oral iron and folic acid supplements.She had no history of allergies or significant past medical illness. On presentation, she was conscious,alert(Glasgow coma scale 15/15) and afebrile. Her pulse rate was 140/min, respiratory rate 28/min, oxygen saturation of 90% at room air and systolic blood pressure 70 mm of Hg. On physical examination, she had marked pallor in mucous membranes. Chest examination revealed bilateral diminished breath sounds; rest of the systemic examination was unremarkable. Her hemoglobin was 6.0 gm/dL, total leucocyte count 27900/μL, red blood cell count 2.86 million/cmm, platelet count 570000/μL, International normalized ratio (INR) 1.13 and APTT 34.4 seconds. Arterial blood gas analysis was suggestive of hypoxia (pH 7.37, po2 66, pco2 44,HCO3 20 and po2/Fio2 0.66 on 100% Fio2). Chest radiograph showed bilateral infiltrates. She had normal urine analysis, serum electrolytes, renal, liver and thyroid function tests. She was treated with intravenous adrenaline, hydrocortisone, antihistaminics and H2 blockers and transferred to the intensive care unit for ventilatory and inotropic support.\nDespite intensive resuscitation attempts in the intensive care unit, the patient expired due to cardiac arrest within 24 hrs.