Cerebral thrombosis in two patients with malabsorption syndrome treated with vitamin K.

(1) A 59-year-old woman had for 20 years suffered from episodes of abdominal pains and diarrhoea and had been constantly underweight. She was admitted to hospital in 1977 because of increasing diarrhoea, progressive weight loss, and fluid retention. She weighed only 40 kg and had generalised oedema and subcutaneous ecchymosis. Her erythrocyte sedimentation rate (ESR) was 6 mm in 1 h, haemoglobin concentration 12-6 g/dl, platelet count 370 x 109/1 (370000/mm3), and thrombotest (TT) <5%. Serum concentrations were: calcium 1-05 mmol/l (4-2 mg/100 ml), iron 8 jVmol/l (44-6 Fg/ 100 ml), total iron binding capacity 14 pmol/l (74 ug/100 ml), albumin 25 g/l, cholesterol 3-13 mmol/l (120-8 mg/100 ml). Jejunal biopsy showed partial villous atrophy and infiltration of chronic inflammatory cells. She was treated immediately with fluids, electrolytes, albumin, vitamin K 10 mg intravenously, and a gluten-free diet. The subsequent TT values are shown in the figure. Twelve days later she developed left-sided hemiplegia. She died three months later. Necropsy showed slight atheroma, old ischaemic infarctions in the left hemisphere and pons, and a recent thrombus in the left hemisphere. Extensive histological examination of the small intestine confirmed the findings of earlier biopsies.