Warfarin Hypersensitivity Due to Gluten-Sensitive Enteropathy: A Case Study

Sara Kwolek; Paula Deming

doi:10.29074/ascls.25.2.78

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Sara Kwolek, BS MLS(ASCP)^CM
1. Laboratory Services, Glens Falls Hospital, Glens Falls, NY
Paula Deming, Ph.D., MLS(ASCP)^CM⇑
1. Medical Laboratory and Radiation Sciences, University of Vermont Burlington, VT

Address for Correspondence: Paula Deming, Ph.D., MLS(ASCP)^CM, Medical Laboratory and Radiation Sciences, University of Vermont, 106 Carrigan Drive, Rm. 302 Rowell Building, Burlington, VT 05405, (802) 656-2506, paula.deming{at}uvm.edu

Abstract

A 53 year old female who was maintained on long-term warfarin therapy due to history of pulmonary embolism, repeatedly presents with an abnormally prolonged Prothrombin Time (PT) and Activated Partial Thromboplastin Time (APTT). After many asymptomatic episodes were corrected with Vitamin K therapy to temporarily reverse the effects of the warfarin, the cause of the apparent coagulopathy was further investigated. Factor Activity Assays of the common pathway factors II, IX, and X all revealed critically low values; below the threshold even a loading dose of warfarin is typically capable of eliciting. The patient tested strongly positive for Tissue Transglutaminase IgA, which is highly suggestive of a gluten-sensitive enteropathy. One effect of this condition is malabsorption due to flattened intestinal villi.¹ The patient was determined to have an acquired vitamin K deficiency secondary to gluten-sensitive enteropathy. Her condition was exacerbated by the long-term warfarin therapy, resulting in the prolonged PT and PTT. The patient was treated with vitamin K therapy, which reversed the deficiency and corrected her abnormal coagulation results.

ABBREVIATIONS: PT- prothrombin time, APTT- activated partial thromboplastin time, INR- international normalized ratio, CD- celiac disease