Covid fear leads to bleed: What is the cause?

Aims & Objectives: Aim: To describe an unexpected clinical condition during the pandemic due to Covid 19 Objectives: (1) To understand the effects of allopathic and alternative medicines at inappropriate doses on coagulation (2) To understand the need of full coagulation work up to provide proper treatment Patients/Materials & Methods: Present : A 47 year old gentle man was referred to haematologist for prolonged coagulation screen and factor X deficiency Past : He had echymoses in the lower limbs and hematuria 2 months back Nephrology & Urology opinion: Nil abnormality detected Coagulation screen (prothrombin time & partial thromoplastin time) prolonged InvestigatIon for common pathway factors show low Factor X 3 units of fresh frozen plasma transfused to arrest hematuria and echymoses (These past events happened elsewhere and was verified from his case file) Two years back he had plate implant without transfusion support for fracture femur which occurred due to road traffic accident He has no comorbid conditions or bleeding history Family history: No significant illness or bleeding history Occupation: Pharmacist Drug history: (1) Diclofeanac paracetamol 2 tabs/day for two years for pain (2) Antihiastamines and antifungals for echymoses (3) Kabasurakudineer and many other decotions for fear of Covid 19 Results: Diagnosis: Acquired Vitamin K dependent factor deficiencies Treated with Vitamin K 10 mg orally daily for 3 months Follow up: coagulation screen within reference range Discussion & Conclusion: 1 Diclofenac known to inhibit platelet aggregation will interfere with coagulation? As in rats 2 Alternate system medicines interfere with vitamin K+ 3 Diclofenac and alternate medicines interaction cause vitamin k deficiency? 4 Lot of drugs causing malabsorption? Medications of all streams need physician guidance and follow up Full coagulation work up is diagnostic and aids in treatment