Acquired Deficiencies Diseases Of Vitamin K—dependent Coagulation Factors

Objective By the clinical data on40cases of acquired deficiencies ofvitamin K-dependent coagulation factors (VKDCFs) analysis to investigate thecause of VKDCFs, diagnosis，treatment options and application of bloodproducts.Method Reviewed the clinical data of VKDCFs of patients with40caseswho hospitalization in the First Affiliated Hospital of Guangxi MedicalUniversity in April2005to December2011: etiology, clinical characteristicsand monitoring the change of coagulation function after and during vitamin K1treatment and the course of treatment. And telephone follow-up of all patients.Results1、In40patients: there were25males and15females, median age48years (15years old to82years old), male:female was1.67:1. Five cases ofnewly diagnosed due to other department od misdiagnosis of income,including2cases of hematuria income urologist,2cases of nasal mucosableeding income ENT,1case of gastrointestinal bleeding revenue ofgastroenterology, the misdiagnosis rate of12.5%. Follow-up cut-off date ofMarch31,2012, the median follow-up time was38months (4months to7years). Follow-up results: no patient lost to follow; of with35patients with no recurrence,3cases in one week, six weeks, five month recurrence,2cases died.2、In40patients:17cases have a clear history of the poison (oral intake of11cases,6cases of suicide.7cases of Bromadiolone poisoning,5cases ofdiphacinone poisoning,2cases of brodifacoum poisonning,3cases failedto provide the rodenticides type indeed).9cases of patients with suspectedpoisoning history, their place of residence had put rodenticides orlong-term history of exposure to rodenticides (3cases of Bromadiolone,3cases of diphacinone,2cases of brodifacoum,1cases of warfarin),5cases for unspecified reasons.9cases use of herbal medicine (Of which4cases failed to provide the Chinese herbal medicine types,3cases ofChinese herbal wine,2cases of desmodium).3、Clinical manifestations: skin patechiae, hematuria, mucosal bleeding,menstrual increase in bleeding for the first symptom of multiple sites as themain performance, the common bleeding sites were the skin patechiae in25cases (62.5%), gross hematuria in19cases (47.5%), joint and musclehematoma in18cases (45%), mucous membrane bleeding in16cases(40%), melena in9cases (22.5%), vaginal bleeding in7case (17.5%).4、Laboratory features: Routine blood test showed that the platelets werenormal; APTT and PT were significantly prolonged.5、Treatment: after vitamin K1therapy12h,1d,3d,7d detection ofprothrombin time (PT), activated partial thromboplastin enzyme time(APTT) that was significantly shorter (P<0．01).Conclusion1、Anticoagulant rodenticide poisoning is a common cause of VKDCFs.2、The clinical manifestation is multi-site hemorrhage, of which skin petechiae is the most common.3、Laboratory tests: to the PT and APTT were significantly polonged as themain performance, the PT and APTT testing can be used as screening testsand the efficacy of monitoring indicators of the disease.4、Treatment: vitamin K1treatment of VKDCFs should be enough dose, alonger course of treatment, and the large amount of bleeding orlife-threatening bleeding should add the plasma or prothrombin complex.5、The prognosis is good, multiple sites for unexplained bleeding, PT andAPTT were significantly prolonged, you should consider the possibility ofpoisoning by the anticoagulant class of rodenticides. Timely diagnosis andtreatment of VKDCFs is important.