Acute iron intoxication with abruptly reduced levels of vitamin K-dependent coagulation factors

A 17-year-old girl swallowed at least 50 Duroferon duretter. Each tablet contains ferrous sulphate equivalent to 0.1 g Fe2+. Thus, a total of 5 g Fe2+ was ingested. Vitamin K-dependent coagulation factors dropped within the next hours to very low levels. Thrombotest showed less than 3% of normal coagulation activity 8 h after oral intake. Recovery was uneventful except for laboratory evidence of transient liver damage. The rapidity by which the early coagulation deficiencies developed and the lack of evidence of disseminated intravascular coagulation suggested a direct effect of iron on coagulation factors. In vitro studies confirmed that iron in concentrations that may have been attained in vivo, altered the functional activity of several coagulation factors. Monitoring the vitamin K-dependent coagulation factors may be a simple and useful parameter in acute iron intoxication.