A woman from central Illinois has become the fourth person in the state to die from synthetic marijuana, officials announced Tuesday. 
 
 The woman, whose name was not disclosed, was in her 30s, the Illinois Department of Public Health reported. 
 
 Previously, two men, one in his 20s and another in his 40s, died in central Illinois, along with a Chicago-area man in his 20s. 
 
 Health officials reported that 153 people in 13 counties in Illinois have gotten sick from synthetic cannabinoids believed to be laced with rat poison. Most victims are from the Chicago and Peoria areas. 
 
 Synthetic marijuana is not marijuana at all but man-made chemicals sold on the premise that they act on the same brain cell receptors as the main psychoactive ingredient in cannabis, THC. 
 
 In recent weeks, victims have begun showing up in hospital emergency rooms after coughing up blood, bleeding in the urine, nose or gums, or having internal bleeding, officials said. It was determined that they were suffering from a chemical found in rat poison called brodifacoum, which prevents blood from clotting. Officials said the poison is believed to have been mixed in with the synthetic marijuana. 
 
 Patients are treated with intravenous transfusions of vitamin K to restore their blood’s clotting ability, followed by vitamin K pills. On Monday, officials announced a donation of nearly 800,000 vitamin K tablets by the Bausch Foundation, a philanthropic arm of Valeant Pharmaceuticals International Inc. in Laval, Quebec. 
 
 rmccoppin@chicagotribune.com 
 
 Twitter @RobertMcCoppin 
 
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 On Friday, the Illinois Department of Public Health reported that 32 people in the past few weeks visited emergency rooms with severe bleeding after using a synthetic cannabinoid product. That’s up from the 22 cases the state reported just the day before. 
 
 The department also released a geographic breakdown, reporting eight cases in Chicago, four in suburban Cook County and one each in Will, DuPage, Kane and McLean counties. The hot spot seems to be the Peoria area, with Tazewell County reporting 10 cases and neighboring Peoria County six. 
 
 Most of those affected were in the Chicago area, but health officials warned the contaminated products also could be present elsewhere across the state, said department spokeswoman Melaney Arnold. 
 
 The health department said Thursday that symptoms have included bleeding from the eyes and ears. On Friday, officials clarified that while this can happen, those affected in Illinois have reported other symptoms, like coughing up blood, blood in urine, bloody noses, bleeding gums and, for women, heavier than usual menstrual flow. 
 
 Though synthetic pot has long been considered dangerous, severe bleeding is not a known side effect, said Dr. Melissa Millewich, an emergency room physician at Advocate Good Samaritan Hospital in Downers Grove. 
 
 “This bleeding is not expected, at least in such a significant population so quickly,” she said. 
 
 Despite a statewide ban, Arnold said manufacturers could be slightly tweaking the molecular makeup of the products as a way to “get around” the law, allowing for them to be sold legally. They are also sold on the street, she said, and those experiencing the bleeding said they obtained the products in convenience stores and from dealers and friends. 
 
 Health officials reported 32 people who experienced the symptom since March 7, and they continue to track the situation, Arnold said. So far, there are no deaths reported. 
 
 A change in the latest formula could be behind the new, dangerous symptom, Millewich said. Because health officials don’t know the exact makeup of the products, it’s unclear what’s causing the bleeding, she added. 
 
 While there have been no such cases at Good Samaritan’s ER, Millewich said, synthetic pot, often called “fake weed,” “K2” or “spice,” has previously displayed life-threatening symptoms like kidney failure, along with psychosis. 
 
 “People don’t realize how dangerous this is,” she said. 
 
 The man-made substance is a mixture of hundreds of chemicals, often called cannabinoids because they affect the same brain cell receptors as the main ingredient in marijuana. Cannabinoids are sometimes sprayed on plant material for smoking, or are sold as liquids to be vaporized and inhaled in e-cigarettes and other devices, the health department’s warning said. The products are also sometimes referred to as herbal or liquid incense. 
 
 Recent patient reports of severe bleeding led health officials to warn the public not to use any synthetic cannabinoid products. 
 
 While those affected by the outbreak admitted using cannabinoids, it’s been difficult to determine their exact source for the substance, Arnold said. 
 
 Dr. Nirav Shah, director of the public health department, says there’s an erroneous perception that synthetic cannabinoids are a safe and legal alternative to marijuana. 
 
 Shah says they're unsafe because it's difficult to know what chemicals they contain or what an individual's reaction will be. 
 
 A Centers for Disease Control and Prevention study found there’s also an association between teens who use synthetic pot and a heightened risk for violent behavior, risky sex and abuse of other drugs. 
 
 Anyone who uses these drugs and experiences unexplained bleeding or bruising is advised to call 911 or have someone take them to an emergency room. 
 
 Associated Press contributed. 
 
 kthayer@chicagotribune.com 
 
 Twitter @knthayer ||||| (CNN) Synthetic cannabinoids -- often called Spice, K2 or fake weed -- have been tied to 56 cases of severe bleeding , including two deaths, across Chicago and areas in central Illinois. 
 
 All of the cases required hospitalization related to coughing up blood, blood in the urine, bloody nose, bleeding gums and other symptoms. Nine of the cases tested positive for brodifacoum, or rat poison, according to a statement from the Illinois Department of Public Health on Monday. 
 
 Now, state officials are working to identify any common synthetic cannabinoid products related to those cases and to determine where the products were obtained. 
 
 There are still many questions about the illnesses; officials are not aware what exactly caused the drug contamination, but investigators and toxicologists are continuing to evaluate. 
 
 "This is the first time we've seen an outbreak of this magnitude in the area," Melaney Arnold, a spokeswoman for the Illinois Department of Public Health, said Monday. 
 
 "We're working with numerous different partners across the city and state as we investigate this outbreak," she said. 
 
 Synthetic cannabinoids are sold in convenience stores, gas stations, drug paraphernalia shops, novelty stores and even online. 
 
 Health officials warn that anyone who has a reaction to synthetic cannabinoids immediately should call 911 or be taken to an emergency department. 
 
 'There could be additional deaths coming' 
 
 "We continue to see the number of cases rise," Dr. Nirav Shah, director of the Illinois Department of Public Health , said in the statement. 
 
 The department "is continuing to work with local health departments and the Centers for Disease Control and Prevention, along with other partners, to try to identify common products," he said. "Without more information, IDPH does not know how much contaminated product is circulating or where. We strongly urge everyone not to use synthetic cannabinoids." 
 
 Though 17 of the recent cases were tied to synthetic cannabinoid products in Chicago, contaminated products could be statewide, the Department of Public Health noted 
 
 There also were five cases in Cook County, two in Kankakee County, 14 in Peoria County, 12 in Tazewell County and one in each of the counties of DuPage, Kane, McLean and Will. Two other cases are under investigation. 
 
 One of the deaths was in Chicago and the other in central Illinois. 
 
 Officials had never before seen a death in Chicago related to fake weed, Arnold said. 
 
 "There could be additional deaths coming; it is difficult to say," she added. "We're doing whatever we can with regards to outreach to notify any who may be impacted by this outbreak." 
 
 What is fake weed? 
 
 This isn't the first time a region of the United States has seen an outbreak of health problems tied to synthetic cannabinoids. 
 
 Last year, 102 people in Lancaster County, Pennsylvania , overdosed on synthetic marijuana within three days. None of those cases was fatal. 
 
 In 2016, 33 people in Brooklyn were made ill from suspected overdoses of synthetic pot. 
 
 During that time, physicians treated 456 patients total for synthetic cannabinoid intoxications. 
 
 Synthetic cannabinoids, or fake weed , are human-made chemicals that can be sprinkled on dried, shredded plant material and smoked, or can be consumed as vaporized liquids inhaled through an e-cigarette or other device. 
 
 These mind-altering chemicals are called cannabinoids, since they are similar to the chemicals found in marijuana, though they can cause serious side effects that are different from those of marijuana. 
 
 One study of a synthetic cannabinoid found that it was 85 times as potent as tetrahydrocannabinol, or THC, the mind-altering chemical in marijuana. That study was published in the New England Journal of Medicine in 2016. 
 
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 People who smoke synthetic cannabinoids can have rapid heart rate, vomiting, agitation, confusion and hallucinations, according to the CDC. 
 
 In the past few years, doctors have become familiar with the health outcomes people can face when they are exposed to synthetic cannabinoids, said Dr. Patrick Lank, an emergency physician and assistant professor of emergency medicine at the Northwestern University Feinberg School of Medicine in Illinois. 
 
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 "They include things like seizures, heart attack, kidney failure," said Lank, who was not involved in the recent synthetic cannabinoid cases. 
 
 "What's happening in Illinois is different, and these are bleeding complications. Why they're happening? We're still uncertain," he said. "We don't know if the supply of synthetic cannabinoids in Illinois and the Chicago area have been tainted by someone with brodifacoum, or rat poison. Or if this is potentially a new side effect of a new synthetic cannabinoid."
– Another person in Illinois has died after using synthetic marijuana, reports the Chicago Tribune. The central Illinois woman, who was in her 30s, is the fourth person to die in the state after apparent use of the tainted substance. She's the third central Illinois victim; the fourth was from Chicago. In the last few weeks, more than 150 people across 13 counties have been hospitalized after using synthetic pot laced with what health officials believe to be a type of a rat poison known as brodifacoum, a powerful anti-coagulant. A widely used pesticide, when ingested by humans brodifacoum can cause bleeding from the nose or gums, as well as internal bleeding. Symptoms include coughing up blood and bloody urine, health officials say, and brodifacoum poisoning can be treated with vitamin K administered via IV to stabilize the blood’s clotting ability. The treatment is effective if initiated before excessive bleeding occurs, per the American Council on Science and Health. CNN reports health officials urge anyone who has a reaction to synthetic marijuana to call 911 or go to an emergency room.