title: [46-year-old woman with multiple hematomas and bleeding of the base of the tongue: phenprocoumon poisoning].
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.
authors.affiliation: Hämatologisches Zentrallabor der Universität, Inselspital, Bern.
authors.forename: K
authors.initials: K
authors.lastname: Kriz-Kozak
authors.forename: B
authors.initials: B
authors.lastname: Lämmle
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage / Q000097:blood / Q000506:poisoning*; D001780:Blood Coagulation Tests; D062787:Drug Overdose / Q000097:blood / Q000175:diagnosis*; D005260:Female; D006406:Hematoma / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis; D006474:Hemorrhagic Disorders / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis; D006801:Humans; D008875:Middle Aged; D010644:Phenprocoumon / Q000008:administration & dosage / Q000097:blood / Q000506:poisoning*; D014060:Tongue Diseases / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis; D014859:Warfarin / Q000008:administration & dosage / Q000097:blood / Q000506:poisoning
chemical_list: D000925:Anticoagulants; D014859:Warfarin; D010644:Phenprocoumon