Anaphylaxis to Benzodiazepines: A Rare Phenomenon and Review of Literature

Abstract

unit admission, packed red blood cells transfusion, and transient norepinephrine infusion. Repeat computed tomography abdomen and pelvis (Figures 1 and 2) showed mild worsening of the large right gluteal hematoma without any active extravasation. Rotational thromboelastometry (ROTEM) showed good clot formation without any coagulopathy. Patient was transferred to the medical floor after stabilization of her medical condition and subsequently discharged home.Tyrosine kinase inhibitors including dasatinib have an essential role in the management of CML. Patients may require indefinite tyrosine kinase inhibitor therapy and it is very important to be aware of their potential adverse effects. Fatigue, headache, edema, rash, and hypertension are the common adverse effects. 1 Congestive heart failure, pleural effusion, arrhythmia, pulmonary hypertension, and bleeding are more significant adverse effects. 1,2 Among TKIs, dasatinib is most frequently associated with bleeding. Studies have reported a bleeding rate ranging 12%-40% due to dasatinib. 3 Dasatinib can cause bleeding in the upper gastrointestinal tract (22%), lower gastrointestinal tract (59%), gingiva (11%), vagina (5%), and nares (3%). 4 Dasatinib can cause bleeding even in the absence of thrombocytopenia suggesting a possible hemostatic defect. The exact mechanism by which dasatinib causes bleeding is unknown. However, it is suspected that dasatinib may alter platelet aggregation by impairing arachidonic acid and epinephrine-induced platelet aggregation and by inhibiting kinases in platelet homeostasis (SFK, LYN, FYN). Inhibition of SFK prevents platelet aggregation and adhesion. 5 Dasatinib has been shown to induce higher and faster rates of major molecular response and complete cytogenetic response when compared with imatinib. 6 Because dasatinib is used more frequently as a first line agent of CML management, clinicians should be cognizant of potential unique hemorrhagic presentations from its use. Our patient experienced spontaneous gluteal hematoma because of dasatinib use, which is rare. It will be worthwhile reporting this potential adverse effect of dasatinib to the current literature.