Author(s)

Kang Du ¹

Affiliation(s)

¹ Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China

Corresponding Author

Kang Du

ABSTRACT

Perioperative anaphylaxis to neuromuscular blocking agents is rare but fatal; its coagulopathic sequelae are under-recognized, and rocuronium is the most frequently incriminated agent. Mast cell tryptase cleaves fibrinogen and activates protease-activated receptor-1, inducing consumption of hemostatic reserves, whereas drug-dependent antibodies may destroy platelets; their concurrent presentation with cardiac arrest is unreported. We report a 72-year-old man who, despite tolerating rocuronium four months earlier, developed fulminant anaphylactic shock with pulseless electrical activity arrest upon re-exposure during induction of elective ileostomy reversal; surgery was aborted immediately. Post-resuscitation tryptase (42.3 μg/L vs baseline 4.1 μg/L) satisfied the anaphylaxis diagnostic algorithm. Severe coagulopathy ensued (fibrinogen 0.79 g/L, platelet count 13×109/L); thromboelastography (TEG) showed hypocoagulability without fibrinolysis. Serial TEG-guided transfusion of irradiated apheresis platelets, fresh frozen plasma and fibrinogen concentrate led to rapid improvement, complete neurological recovery, and discharge on hospital day six. Four-week allergologic workup confirmed rocuronium-specific IgE-mediated hypersensitivity (positive skin prick and intradermal tests, elevated specific IgE, negative cisatracurium testing). Rocuronium re-exposure in sensitized individuals can trigger a multisystem coagulopathic storm; TEG-guided resuscitation and thorough allergy workup are critical for patient safety.

KEYWORDS

Rocuronium; Anaphylactic shock; Hypofibrinogenemia; Drug-induced immune thrombocytopenia; Thromboelastography

CITE THIS PAPER

Kang Du. Rocuronium-Induced Anaphylactic Shock Complicated by Coagulopathy and Thrombocytopenia: A Case Report. MEDS Clinical Medicine (2026). Vol. 7, No. 3, 1-8. DOI: http://dx.doi.org/10.23977/medsc.2026.070301.

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