title: Fatality caused by self-bloodletting in a patient with factitious anemia.
abstract: Death by bloodletting among patients with factitious anemia has never been reported to our knowledge. We report the first known case. A 25-year-old woman with severe iron deficiency anemia confessed her habit of bloodletting at her first visit to our hospital, in March 1998. We prescribed oral iron and referred her to a psychiatrist. The diagnosis was borderline personality disorder. The psychiatrist began counseling the patient and prescribed a major tranquilizer. The patient's method of bloodletting was to insert an 18-gauge needle without syringe into her vein after inducing congestion in her arm. This method was considered to involve risk of death, because once the patient fell into a faint caused by blood loss, the bloodletting could not be stopped. Although we attempted to persuade the patient to stop bloodletting by this method, she died after self-bloodletting in September 1999. It is not known whether the death was intentional suicide or an accident.
authors.affiliation: Department of Internal Medicine, Higashi Sapporo Hospital, Sapporo, Japan. yhirayama@hsh.or.jp
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Hirayama
authors.forename: Sumio
authors.initials: S
authors.lastname: Sakamaki
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Tsuji
authors.forename: Tamotsu
authors.initials: T
authors.lastname: Sagawa
authors.forename: Norihiro
authors.initials: N
authors.lastname: Takayanagi
authors.forename: Hiroki
authors.initials: H
authors.lastname: Chiba
authors.forename: Takuya
authors.initials: T
authors.lastname: Matsunaga
authors.forename: Junji
authors.initials: J
authors.lastname: Kato
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Niitsu
mesh_terms: D000328:Adult; D001883:Borderline Personality Disorder / Q000523:psychology*; D005162:Factitious Disorders / Q000523:psychology*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D018962:Phlebotomy / Q000009:adverse effects / Q000523:psychology*; D016728:Self-Injurious Behavior / Q000523:psychology*