For a long time, natural products have been used in the traditional medicines of different cultures. Many active substances used in current pharmacopoeia stem from research within this field. They are widely used, although their use is a source of controversy. A significant proportion of these products are normally contraindicated for patients on dialysis due to their possible deleterious effects.

We present the case of a 63-year-old woman from New Delhi, India, with chronic kidney disease of unknown cause who has been undergoing a chronic haemodialysis programme since March 2015 through a central venous catheter (CVC). She underwent a radiocephalic left arteriovenous fistula (RC lAVF) in September 2015. Following a maturation period, lAVF punctures were initiated, with haematomas developing at the puncture sites, and a lengthening of the haemostasis time of more than 2h, with bleeding at home and a need for referral to the emergency department on multiple occasions, the dialysis parameters were adjusted to use a technique without heparin, antiplatelet therapy was suspended and heparin sealing of the CVC was minimised. However, the increased haemostasis times persisted, and there were also spontaneous bleeding episodes due to the lAVF at her home. A fistolugram was performed with normal results. In the laboratory tests, an altered prothrombin time (PT) of 63s and an activated partial thromboplastin time (aPTT)>140s were observed. No underlying liver disease was revealed, and the patient was not taking oral anticoagulants. In light of this finding, the patient was questioned again. She reported taking turmeric infusions on a daily basis in quantities of 3–5g. We decided to suspend these infusions after reviewing the literature which mentions a possible anticoagulant effect, as well as boosting the effects of antiplatelet therapy. After 2 weeks of not using the lAVF and of abstaining from the turmeric infusions, normal clotting times were displayed and the lAVF punctures were started again with no new haemorrhage incidences being presented until now.

Turmeric (Curcuma longa) is native to south-west India. It is a herbaceous perennial plant from the Zingiberaceae family. The most important chemical components of turmeric are a group of compounds called curcuminoids (curcumin or diferuloylmethane, demethoxycurcumin and bisdemethoxycurcumin).1 It also contains volatile oils such as turmerone, atlantone and zingiberene, as well as sugars, proteins and resins. Curcumin is responsible for its yellow colouring. Turmeric is used routinely as a spice, especially in Indian cuisine, and as a food colouring. Turmeric is now also used as a textile dye, and it is used to dye wool, cotton, silk, leather, waxes, stains, etc.2 A wide range of biological and pharmacological activities of turmeric has been researched. These include antioxidant, anti-inflammatory, antiviral, antifungal, hepatoprotective, anti-cancer, antimicrobial, cardiovascular, gastrointestinal, nephroprotective, anticoagulant and anti-diabetic effects.2 Curcumin may bind to heavy metals such as cadmium and lead, reducing their toxicity. It also acts as an inhibitor of cyclooxygenase, 5-lipoxygenase and glutathione S-transferase, which converts it into an antioxidant, like vitamins C, E and beta-carotene.2 The anti-inflammatory action of turmeric is probably due to a reduction in histamine production and also due to the fact that it increases and prolongs the action of cortisol. Turmeric acts by stimulating bile production, improving fat metabolism.2 Pharmacokinetic studies in animals3 have demonstrated that 40–85% of oral curcumin passes through the gastrointestinal tract without changes, the rest being absorbed by the intestinal mucosa and the liver. Due to its low rate of absorption, curcumin often combines with other compounds to increase absorption and boost the anti-inflammatory effect. It has rapid hepatic elimination following intravenous infusion, and it is a compound which is rapidly metabolised.2 The anticoagulant effects of turmeric were analysed in an in vitro/in vivo study. It was demonstrated that turmeric inhibited the action of thrombin, factor Xa and increased the aPTT and PT.4

In the case that we present, the intake of high quantities of turmeric, with no other influencing factor, seems to be related to an increase in PT and aPTT, which were reversed after stopping the intake, with the altered parameters normalising.