Abdul Mannan: Severe Coagulopathy and the Importance of Drug History
Abdul Mannan, Consultant Haematologist, Director Haemophilia Centre, Haematology Lab Lead at Betsi Cadwaladr University Health Board, shared a post LinkedIn about a recent article by Abhijith Lakshman et al., published in JCDR, adding:
“A painful hip. A bruised thigh. A PT of 70 seconds.
A 47-year-old man presented with hip pain and bruising. He had a previous hip prosthesis, had used NSAIDs intermittently, and had taken alternative medicines whose ingredients were unknown.
His laboratory results told the next part of the story:
- PT: 70.4 seconds
- APTT: 46.8 seconds.
- After mixing: PT 15.1 seconds and APTT 26.7 seconds.
- Factor II: 24.6 percent; VII: less than 5 percent; IX: 7.9 percent; X: 23.3 percent.
He received vitamin K, and his coagulation parameters normalised after three days.
The pattern and response point towards a vitamin K-responsive coagulopathy. The harder question is why. The authors suggest possible medication-related mechanisms, but the case does not prove that either NSAIDs or the unidentified products caused the abnormality.(Lakshman et al., 2024)
For me, the teaching point is simple: a good drug history includes what the patient bought, borrowed, was given and thought was harmless.
What would you ask next, and which results would you want before settling on the cause?
Educational discussion for clinicians; management depends on bleeding severity and local guidance.”
Title: Multiple Coagulation Factor Deficiency: A Series of Eight Cases
Authors: Abhijith Lakshman, Febe Renjitha Suman, Gramani Arumugam Vasugi
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