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