Munchausen syndrome in hematology: case reports of three variants and review of the literature.

We describe five patients with hematologic Munchausen syndrome who were discovered within 5 years. The patients presented for hematologic evaluation of coagulopathy, iron-deficiency anemia, or macrohematuria with severe anemia. The final diagnoses were phenprocoumon intake (2x), self-inflicted phlebotomy (2x), and urogenital manipulation (1x). All five patients were female ranging in age between 23 and 45 years; two were nurses. In four cases we were able to unmask the patient. We think that hematologic Munchausen syndrome has a rather uniform pattern and may be divided into three subtypes: (a) anticoagulation type, (b) anemia type, and (c) pretended hematologic form. Hematologic Munchausen syndrome should especially be considered if there is an unexplained coagulation disorder or therapy-resistant iron-deficiency anemia, and if the patient is a young female nurse who has had many hospitalizations.