Citation

Kriz-Kozak K, Lämmle B. Ther. Umsch. 1999; 56(9): 541-543.

Vernacular Title

46jahrige Frau mit multiplen Hamatomen und Zungengrundblutung:

Affiliation

Hämatologisches Zentrallabor der Universität, Inselspital, Bern.

Copyright

(Copyright © 1999, Verlag Hans Huber)

DOI

unavailable

PMID

10517130

Abstract

A 46-year old nurse complaining of multiple hematomas including bleeding into the tongue was referred for hemostasis evaluation. A very low Quick percentage value, i.e. a severely prolonged prothrombin time with severely depressed vitamin K-dependent coagulation factors (FII:C, FVII:C, FX:C) and normal FV:C and fibrinogen level was found. In the absence of cholestasis, malabsorption and broad-spectrum antibiotic therapy, ingestion of vitamin K antagonists was suspected. Three years previously, she had been on oral anticoagulant treatment with phenprocoumon (Marcoumar) for postoperative pulmonary embolism. She denied having voluntarily ingested anticoagulant drugs. A high plasma level of coumarins was found. To exclude accidental ingestion, the patient's son living in the same household was tested as well. Surprisingly, a low level of coumarin was found also in his plasma. We suspect that the patient voluntarily intoxicated herself and gave a low dose of coumarin anticoagulant to her son as well.

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