Toxicological Analysis of Warfarin in an Adult Developing Diffuse Alveolar Hemorrhage: A Case Report and Literature Review

Abstract

Development and validation of analytical method for the identification and quantification of any drug in blood is vital significance to study drug metabolism and, link clinical results. A 39-year-old woman who arrived in the emergency unit due to bleeding on her mouth twice. In first arriving the hospital, the patient regularly has ingested warfarin for 12 years and has had never an event related-INR until now. There were radiological lesions of the patient, and the INR value was 12. After the treatment, it was suggested that the patient discontinue warfarin, and she was discharged. After 1.5 month, the patient developed severe hypoxia and the INR value was 9 in second visiting the hospital when she said that she didn’t ingest the drug for ten days. After the patient entered dialysis for three days and isolated from outside, the INR and the other values was normal. A blood specimen was sent to our forensic toxicology laboratory with the suspicion of suicidal or homicidal warfarin poisoning. Warfarin concentration determined using validated method by liquid chromatography-tandem mass spectrometer was 2.16 μg/ml. Clinicians should be aware the importance of analytical toxicological analyses to assess a series of forensic and clinical toxicological investigations in analysis of post-mortem and ante-mortem blood samples. Keywords: toxicology; analysis; warfarin; clinical; suicide; homicide. Special Issue of Health Sciences DOI: 10.7176/JSTR/6-03-04