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    Poster Networking

    Coagulation and Natural Anticoagulants

    Poster Networking Session

    PB1062 - Exogenous warfarin intoxication associated with Munchaüsen Syndrome

    Tuesday, June 27, 2023
    18:30 – 19:30 ET
    Room: Exhibition
    Background: Munchausen Syndrome (MS) is a psychiatric disorder in which sufferers intentionally manufacture physical or psychological symptoms to assume the role of the patient, without obvious gain. It has a preponderance for females employed in healthcare fields.

    Aims: To describe 3 cases of exogenous warfarin intoxication, which were referred to the hemostasis service for investigation of hemorrhagic diseases.

    Methods: Descriptive analysis.

    Results: Case 1: Bleeding in the oral cavity and hematuria. Imaging exam showed a clot in the collecting duct of the kidney. Clinical examination showing extensive hematomas. Follow-up in psychiatry, with previous use of sertraline, valproic acid and diazepam. He used warfarin in a suicide attempt. Case 2: She had several hemorrhagic complications in the gastrointestinal and gynecological tract, which were treated with oral vitamin K, prothrombin complex (PCC), tranexamic acid (TA), some with difficult bleeding control. Concomitantly, she had low functional Protein C and Protein S. She had pulmonary thromboembolism after intensive treatment with pro-coagulant medications. Submitted to hysterectomy and right oophorectomy due to severe bleeding. Prophylaxis with PCC was initiated to control bleeding episodes. She had deep venous thrombosis of lower limb, catheter thrombosis and a stroke with hemorrhagic transformation. After the diagnosis of MS, the patient was admitted to a psychiatric clinic. Case 3: Report of hypermenorrhagia since menarche, but with intensification of bleeding episodes two years before the consultation, when she made the diagnosis of Wegener's granulomatosis. She had intense nosebleeds, needing nasal packing, TA and PCC. Tests results in Table 1. All patients alternated between normal and prolonged PT and aPTT and all confirmed exogenous warfarin intoxication.

    Conclusion(s): As combined congenital deficiency of vitamin K-dependent factors is rare (1:2.000.000), exogenous warfarin intoxication should be considered, especially in adult patients seeking hemostasis services for the first time, and these cases are usually associated with psychiatric conditions.