Anaphylaxis-induced hyperfibrinolysis in pregnancy

• Anaphylaxis can cause hyperfibrinolysis by tryptase-initiated activation of the fibrinolytic system.
• ROTEM and TEG, can now diagnose hyperfibrinolysis in a time frame useful to guide clinical management.
• Perimortem caesarean delivery may be necessary for resuscitation of patients diagnosed with anaphylaxis.
• When available, ROTEM or TEG should be performed in pregnant patients with suspected anaphylaxis.

Anaphylaxis during pregnancy is rare but life threatening to both mother and fetus. The anaesthetist may be unexpectedly faced with an obstructing airway, severe bronchospasm and cardiac arrest requiring perimortem caesarean delivery to relieve aortocaval compression. We present a case of anaphylaxis-induced hyperfibrinolysis, an infrequently discussed complication that could exacerbate postpartum haemorrhage and hamper resuscitative efforts.