eMedicine Specialties > Endocrinology > Metabolic Disorders

Vitamin K Deficiency: Differential Diagnoses & Workup

Author: Pankaj Patel, MD, Fellow, Department of Gastroenterology, Winthrop University Hospital and SUNY-Stony Brook
Coauthor(s): Mageda Mikhail, MD, Assistant Professor, Department of Medicine, Division of Endocrinology, State University of New York at Stony Brook
Contributor Information and Disclosures

Updated: Dec 18, 2008

Differential Diagnoses

Acute Lymphoblastic Leukemia
Immune Thrombocytopenic Purpura
Acute Myelogenous Leukemia
Scurvy
Chronic Lymphocytic Leukemia
Thrombotic Thrombocytopenic Purpura
Chronic Myelogenous Leukemia
von Willebrand Disease
Disseminated Intravascular Coagulation
Dysfibrinogenemia
Glanzmann Thrombasthenia

Other Problems to Be Considered

Any bleeding disorder should prompt an investigation to exclude vitamin K deficiency. The best way to differentiate bleeding related to vitamin K (VK) deficiency from that related to hepatocellular failure is through determination of the patient's factor V level. Factor V is synthesized by the liver and is not a VK-dependent factor. In patients with severe liver disease, factor V and VK-dependent factors are low, but in VK deficiency, the factor V level is within the reference range.

Workup

Laboratory Studies

  • An elevation in the level of serum PT and of activated partial thromboplastin time (aPTT) may be found in patients with vitamin K (VK) deficiency. However, it is not uncommon for these patients to have an elevated PT level and a normal aPTT level.12
  • The most sensitive marker is the high level of des-gamma-carboxy prothrombin (DCP), protein in VK absence (PIVKA), measured with appropriate antibodies.13
  • The plasma level of VK (0.2-1.0 ng/mL) can be measured. The level of VK depends on the oral intake of VK, which varies among patients.

More on Vitamin K Deficiency

Overview: Vitamin K Deficiency
Differential Diagnoses & Workup: Vitamin K Deficiency
Treatment & Medication: Vitamin K Deficiency
Follow-up: Vitamin K Deficiency
References
Further Reading
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References

  1. Suttie JW. Vitamin K. In: Machlin L, ed. Handbook of Vitamins. New York, NY: Marcel Dekker; 1984:147.

  2. Van Winckel M, De Bruyne R, Van De Velde S, et al. Vitamin K, an update for the paediatrician. Eur J Pediatr. Nov 4 2008;[Medline].

  3. Shearer MJ. Vitamin K deficiency bleeding (VKDB) in early infancy. Blood Rev. Sep 18 2008;[Medline].

  4. van Hasselt PM, de Koning TJ, Kvist N, et al. Prevention of vitamin K deficiency bleeding in breastfed infants: lessons from the Dutch and Danish biliary atresia registries. Pediatrics. Apr 2008;121(4):e857-63. [Medline].

  5. Beutler E, Lichtman MA, Coller BS. Disorders of the vitamin K dependent coagulation factors. In: Williams Hematology. 5th ed. New York, NY: McGraw-Hill; 1995:1481-5.

  6. Furie B, Furie BC. Molecular basis of vitamin K-dependent gamma-carboxylation. Blood. May 1 1990;75(9):1753-62. [Medline]. [Full Text].

  7. Udall JA. Human sources and absorption of vitamin K in relation to anticoagulation stability. JAMA. Oct 11 1965;194(2):127-9. [Medline].

  8. Furie B. Vitamin K: metabolism and disorders. In: Hoffman R, Benz EJ, Shattil SJ, et al, eds. Hematology: Basic Principles and Practice. 3rd ed. New York, NY: Churchill Livingstone; 2000:1958-62.

  9. Booth SL, Al Rajabi A. Determinants of vitamin K status in humans. Vitam Horm. 2008;78:1-22. [Medline].

  10. Ansell JE, Kumar R, Deykin D. The spectrum of vitamin K deficiency. JAMA. Jul 4 1977;238(1):40-2. [Medline].

  11. Lee GR, Bithell TC, Forester J. Acquired coagulation disorders. In: Wintrobe's Clinical Hematology. 1993. Baltimore, Md: Williams & Wilkins; 1473-80.

  12. Krasinski SD, Russell RM, Furie BC. The prevalence of vitamin K deficiency in chronic gastrointestinal disorders. Am J Clin Nutr. Mar 1985;41(3):639-43. [Medline]. [Full Text].

  13. Liebman HA, Furie BC, Tong MJ. Des-gamma-carboxy (abnormal) prothrombin as a serum marker of primary hepatocellular carcinoma. N Engl J Med. May 31 1984;310(22):1427-31. [Medline].

  14. Merli GJ, Fink J. Vitamin K and thrombosis. Vitam Horm. 2008;78:265-79. [Medline].

  15. Klebanoff MA, Read JS, Mills JL, et al. The risk of childhood cancer after neonatal exposure to vitamin K. N Engl J Med. Sep 23 1993;329(13):905-8. [Medline]. [Full Text].

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Further Reading

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Keywords

vitamin K deficiency, vitamin, vitamin deficiency, coagulation, vitamin nutrition, vitamin supplement, prothrombin, vitamin k nutrition, vitamin deficiencies, vitamin symptoms, vitamin K newborns, vitamin K sources, vitamin K injection, vitamin K supplement, vitamin K supplements, clotting factor, clotting factors, coagulation factor, factor II, coagulation factors, vitamin supplementation, vitamin K1, vitamin K-1, deficiency of vitamin K, hemorrhagic disease of newborn, phylloquinone, vitamin K2, vitamin K-2, menaquinone, vitamin K3, vitamin K-3, menadione, coagulation proteins, fresh frozen plasma

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Contributor Information and Disclosures

Author

Pankaj Patel, MD, Fellow, Department of Gastroenterology, Winthrop University Hospital and SUNY-Stony Brook
Pankaj Patel, MD is a member of the following medical societies: American College of Gastroenterology and American College of Physicians-American Society of Internal Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Mageda Mikhail, MD, Assistant Professor, Department of Medicine, Division of Endocrinology, State University of New York at Stony Brook
Mageda Mikhail, MD is a member of the following medical societies: Endocrine Society
Disclosure: Nothing to disclose.

Medical Editor

Udaya M Kabadi, MD, Professor, Department of Medicine, University of Iowa College of Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Romesh Khardori, MD, Chief, Division of Endocrinology, Metabolism and Molecular Medicine, Professor, Department of Internal Medicine, Southern Illinois University School of Medicine
Romesh Khardori, MD is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Medical Association, American Society of Andrology, Endocrine Society, and Illinois State Medical Society
Disclosure: Nothing to disclose.

CME Editor

Mark Cooper, MBBS, PhD, FRACP, Head, Diabetes & Metabolism Division, Baker Heart Research Institute, Professor of Medicine, Monash University
Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD, Professor of Medicine, St Louis University School of Medicine
George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Medical Practice Executives, American College of Physician Executives, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical Research, Endocrine Society, International Society for Clinical Densitometry, and Southern Society for Clinical Investigation
Disclosure: Nothing to disclose.

 
 
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