[Anaphylaxis after iron dextran administration in a pregnant woman]

Iron deficiency is a frequent cause of anaemia in pregnancy and often results in fatigue and malaise. To prevent complications during labour, timely iron suppletion is important.A 30-year-old multiparous female presented at the outpatient clinic in her 38th week of this pregnancy because of fatigue and lightheadedness. She had been prescribed oral iron suppletion a month earlier but had not taken the tablets. Because her haemoglobin level had decreased to 6.3 mmol/l, it was decided to start her on intravenous iron dextran treatment. During administration of the test dose, the patient experienced acute dyspnoea and severe abdominal and back pain. Foetal bradycardia was observed and the patient underwent an emergency caesarean section. She delivered a healthy boy whose arterial pH was 7.05 (base excess: -7.6 mmol/l) and venous pH was 7.18 (base excess: -6.8 mmol/l).This case demonstrates that dextran anaphylaxis can occur, with potentially lethal consequences, even when no known underlying risk factors are present.