－S 304 －
― F-363 ―
A case of brodifacoum intoxication without a definitive history of superwarfarin exposure.
Department of Internal Medicine, Chungbuk National University College of Medicine, Cheong-ju, Korea
*Ju-Hee Lee, Hyun Kim, Hye-Suk Han, Ki Hyeong Lee, Seung Taik Kim
Brodifacoum is a second-generation anticoagulant rodenticide (superwarfarin) that induces profound and prolonged coagulopathy by disturbing the activity of vitamin K dependent coagulation factors. Superwarfarin intoxications are being increasingly reported, to the extent that it is becoming a comparatively common intoxication. However, few cases of superwarfarin intoxication with an inadvertent cause or unknown origin have been reported. A 58-year-old man with recurrent painless hematuria was found to have an acquired deficiency of vitamin K dependent clotting factors, and a large amount of vitamin K was required to correct the coagulopathy. He had no history of warfarin use or any exposure to rodenticides, but his serum brodifacoum level was 48 ng/mL (a positive result for brodifacoum poisoning). Accordingly, he was diagnosed to be suffering from a vitamin K-dependent coagulation factor deficiency due to accidental exposure to brodifacoum. It is important for physicians to be aware that significant coagulopathy can occur secondary to superwarfarin intoxication, without known exposure. When a patient presents with hemorrhagic coagulopathy and prolonged a prothrombin time (PT) and an activated partial thromboplastin time (aPTT) values of unknown cause, this diagnosis should be considered. Awareness and suspicion for this problem and the prompt initiation of high dose vitamin K therapy can be life-saving in cases of superwarfarin intoxication.
― F-364 ―
Heparin induced thrombocytopenia in a chronic hemodialysis patient with end-stage renal disease
1Department of Internal Medicine, 2Department of Laboratory Medicine, Chungbuk National University College of Medicine, Cheong-ju, Korea
*Jeong-eun Kim, M.D.1, Hye-Suk Han, M.D.1, Soon Kil Kwon, M.D.1, Hye Young Kim, M.D.1, Kyeong Seob Shin, M.D.2, Bora Son, M.D.2, Ki Hyeong Lee, M.D.1, Seung Taik,Kim, M.D.1
Hemodialysis (HD) patients who are continually exposed to heparin are at risk of developing heparin-induced thrombocytopenia (HIT), though HIT is rare in chronic HD patients with end-stage renal disease (ESRD). However, here, the authors report a case of HIT in a chronic HD patient with ESRD, which presented as recurrent thrombocytopenia and significant bleeding episodes. The patient, a 67-year-old man with diabetic ESRD, had been treated with HD since November 2006.He suddenly developed recurrent acute bleeding episodes (petechiae, gross hematuria, and hematochezia) and severe thrombocytopenia (platelet count of < 1.0 X 104/mm3) during previous 2 months since May 2008.These bleeding episodes and severe thrombocytopenia always occurred 1 week after HD with heparin, and improved within 1 week of discontinuing heparin. HIT was diagnosed based on clinical criteria. HD was conducted successfully and thrombocytopenia did not occur after switching agatroban for heparin. HIT is uncommon in ESRD patients, but is equally life-threatening. Therefore, immediate heparin discontinuation in favor of an alternative anticoagulant is essential to avoid serious complications when HIT is clinically suspected in chronic HD patients with ESRD.
