Ross G S, Zacharski L R, Robert D, Rabin D L
Department of Medicine, Dartmouth Medical School, Hanover, NH.
Arch Intern Med. 1992 Feb;152(2):410-2.
A 62-year-old man who presented with gross hematuria was found to have a severe and prolonged coagulopathy. The workup involved mixing studies, which suggested an acquired factor deficiency, and specific factor assays, which demonstrated isolated defects in vitamin K-dependent factors. With vitamin K deficiency excluded, and serum warfarin levels undetectable, so-called superwarfarin ingestion was suspected. This diagnosis was subsequently proved by biochemical evidence (an increase in the serum vitamin K epoxide-vitamin K ratio) and compatible history. This case illustrates how a logical workup can lead to a diagnosis of superwarfarin ingestion, even without a history of such an ingestion. New serum assays for specific superwarfarins are also mentioned. This case report should increase clinicians' awareness of long-acting rodenticide ingestions.
一名62岁男性因肉眼血尿就诊，被发现存在严重且持续时间较长的凝血病。检查包括混合试验（提示获得性因子缺乏）和特定因子检测（显示维生素K依赖因子存在孤立缺陷）。排除维生素K缺乏且血清华法林水平检测不到后，怀疑摄入了所谓的超级华法林。随后生化证据（血清维生素K环氧化物-维生素K比值升高）和相符的病史证实了这一诊断。该病例说明，即使没有摄入超级华法林的病史，通过合理的检查也可诊断出超级华法林摄入。文中还提到了针对特定超级华法林的新型血清检测方法。本病例报告应提高临床医生对长效灭鼠剂摄入情况的认识。
