Acute bleeding tendency caused by chitin-chitosan preparation in a hemodialysis patient

Abstract

A 52-year-old male had been diagnosed with alcoholic liver cirrhosis. He began haemodialysis due to chronic renal failure on 2003. Because of occulusion of the arteriovenous access, he consulted a doctor on June 30, 2004, then he was admitted to our hospital on July 7, 2004, for surgical fistula revision. There was no bleeding tendency observed on preoperative examination. After hospitalization, the catheter for dialysis was inserted into the right internal jugular vein. Thereafter, there was persistent bleeding from the catheter insertion site, and enlargement of the right cervical vein was observed. Because dyspnea became advanced, we began respirator management with endotracheal intubation. At the time of onset, the platelet count was unchanged, but the elongation of the APTT and PT, and the reduction of TTO and HPT were observed. There was no acceleration of the fibrinolysis system, Since Vit K deficiency was suspected, Vit K was administered intravenously. Thereafter, bleeding improved during catheter implantation and serologic data also improved promptly. By a careful examination of his history, it was found that he had been taking chitin-chitosan preparation (one day 30 tablets, with a recommended daily dose of 10 tablets) after preoperative examination. It is considered that the chitin-chitosan preparation affected the absorption of fat-soluble vitamins. Moreover, he had liver cirrhosis, which might result in poor excretion of bile. Since the chitin-chitosan preparation was ingested while bile excretion was declining, it caused a further decrease in bile excretion, then Vit K absorption became poor, leading to acute Vit K deficiency. Since this is the first report of a bleeding tendency caused by chitin-chitosan preparation, we emphasize the need for particular attention to non prescribed health food administration.