Bleeding disorders associated with vitamin K deficiency

Bleeding disorders associated with vitamin K deficiency
Updated: 07/25/2023
© Jun Wang, MD, PhD

General features
  • Bleeding disorders due to nutritional vitamin K deficiency or warfarin use
Clinical presentations
  • History of nutritional deficiency or warfarin use
  • Easy bruising
  • Soft tissue hematoma
  • Other bleeding symptoms
Key risk factors
  • Fat malabsorption syndromes (vitamin K is a fat soluble vitamin)
  • Malnutrition
  • Antibiotics (destroy bacteria producing vitamin K or interfere with vitamin K carboxylation)
  • Newborn: Lack of VK in breast milk, or malabsorption caused by cholestasis, etc
  • Warfarin associated inhibition of regeneration of the active form of vitamin K
  • For Warfarin using patients: > 65, other conditions (atrial fibrillation, GI bleeding, cerebrovascular disease, etc), concomitant medications (aspirin, amiodarone)
Key pathogenesis
  • Impaired production of active factors II, VII, IX and X and proteins C and S
  • Warfarin inhibits vitamin K reductase, reduced level of reduced vitamin K, that is needed for vitamin K dependent carboxylase
Key Laboratory findings
  • Mild: Prolonged PT, normal aPTT
  • Severe: Prolonged PT and aPTT
Management
  • Factors replacement: Fresh frozen plasma, etc
  • Vitamin K supplementation
  • Treatment of underlying diseases



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