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Surreptitious Coumadin Ingestion

Patient Presents

22-year-old white female. This was her eighth admission to the Health Center for diabetes mellitus management.

Admitted: 3-14-96

Discharged: 3-26-96

Ms. L noted the onset of easy bruisability approximately one month prior to admission. Approximately one week prior to admission, she developed spontaneous ecchymoses and hematuria associated with left sided flank pain. She was evaluated in the outpatient clinic and found to have a prolonged PT and APTT to three times normal with elevated fibrin spit products but normal peripheral smear and platelet count. In addition, one to one mixing studies corrected to normal. She was treated with three doses of oral vitamin K with no improvement.

Lab tests

3/14/96

PT 31.2 sec ( 11.5-13.0 )
APTT 93.5 sec ( 21.9-30.3 )
FDP > 40 mg/ml
I 550 mg/ml
Plt Ct 406,000

What do these preliminary laboratory studies indicate?

What further laboratory studies would be helpful?