The Litvinenko Inquiry

The Litvinenko Inquiry
and noted that his falling platelet count created a risk of bleeding. In order to
maintain the platelet count, Mr Litvinenko was given a blood transfusion.
Dr Nathwani noted that, although the level of thallium in Mr Litvinenko’s blood
had been abnormal before his transfer to UCH, it was not elevated to the level
that would indicate that he had been poisoned. The clinical picture at that time
was one of bone marrow failure together with mucosal gut damage and hair
loss; and Dr Nathwani was surprised to note that, given such serious symptoms,
Mr Litvinenko did not have any significant damage to his nerve endings and had
relatively low thallium levels. 144 Fundamentally, Dr Nathwani remained puzzled by
Mr Litvinenko’s clinical presentation, and was concerned that it did not fit squarely
with a diagnosis of thallium poisoning 145
g. Mr Litvinenko’s renal function then began to deteriorate and his blood was
artificially filtered to remove toxins. This further complication added to the puzzle
but Dr Nathwani observed in evidence that it is not unusual for patients with a
persistent infection and a high temperature that is unresponsive to antibiotics to
present with a gradual deterioration of other organs; he added that this is quite
common in patients with bone marrow failure. But he was more surprised to note
that Mr Litvinenko’s liver function was also decreasing 146
h. Dr Nathwani described fishing for diagnoses and further samples were taken in
order to look for chromosomal changes. 147 His registrar, Dr Kim Ryland discussed
Mr Litvinenko’s condition with Dr Dargan at Guy’s Hospital poisons unit. She
noted her colleagues’ concerns that, clinically, Mr Litvinenko was not behaving
like a patient with thallium poisoning because of the absence of neurotoxicity and
the profound pancytopaenia (the absence of all types of blood cells). A further
urine sample was sent to Guy’s and the registrar at Guy’s advised continuing
with ‘Berlin blue’ (which Dr Nathwani explained is the same as Prussian blue)
for seven to ten days and until urinary levels returned to normal, and that other
causes of Mr Litvinenko’s clinical presentation should be considered as thallium
poisoning did not appear to be the primary cause 148 of his condition
i. Dr Nathwani discussed Mr Litvinenko’s condition again with Dr Dargan at
Guy’s poison unit on 21 November. Dr Dargan confirmed that they did not think
Mr Litvinenko had thallium poisoning. Dr Dargan advised that Dr Nathwani
investigate whether radioisotopes could be a potential cause, and gave
Dr Nathwani the contact details for the Atomic Weapons Establishment (AWE).
The poison unit’s note of this conversation records the unit’s view that there are
only a few agents that would cause isolated mucositis and bone marrow failure 149
j. Mr Litvinenko’s condition continued to deteriorate on 21 November and during
that night, he suffered two cardiac arrests from which he was resuscitated. 150 On
22 November, doctors stopped treating Mr Litvinenko with Prussian blue as they
were by then certain that he was not suffering from thallium poisoning
144
Nathwani 18/109-110
145
Nathwani 18/111
146
Nathwani 18/111-112
147
Nathwani 18/113
148
Nathwani 18/114-117
149
Nathwani 18/123-124
150
Nathwani 18/127
38