Vitamin K Deficiency Workup

  • Author: Dieu-Thu Nguyen-Khoa, MD; Chief Editor: George T Griffing, MD   more...
 
Updated: Feb 23, 2012
 

Approach Considerations

Note the following laboratory test results:

  • Measurements of serum PT and PTT: Patients with VK deficiency tends to have an elevated PT and a normal aPTT.[15] Both PT and aPTT can be elevated in more severe deficiency states.
  • Measurements of des-gamma-carboxy prothrombin [DCP]: This is a most sensitive marker, which is elevated in VK deficiency states.[17]
  • Measurement of protein in VK absence [PIVKA]: This level is also elevated.[17]

The plasma level of VK (0.2-1.0 ng/mL) can be measured; however, the level of VK depends on the oral intake of VK, which can vary among patients.

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Contributor Information and Disclosures
Author

Dieu-Thu Nguyen-Khoa, MD  Associate Professor of Clinical Medicine, University of California, Los Angeles, David Geffen School of Medicine; Physician Specialist, Department of Primary Care and Community Medicine, ValleyCare Olive View-UCLA Medical Center

Dieu-Thu Nguyen-Khoa, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, and American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Pankaj Patel, MD  Fellow, Department of Gastroenterology, Winthrop University Hospital and The School of Medicine at Stony Brook University Medical Center

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.

Mageda Mikhail, MD  Assistant Professor, Department of Medicine, Division of Endocrinology, The School of Medicine at Stony Brook University Medical Center

Mageda Mikhail, MD is a member of the following medical societies: Endocrine Society

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.

Additional Contributors

Romesh Khardori, MD, PhD, FACP Professor of Endocrinology, Director of Training Program, Division of Endocrinology, Diabetes and Metabolism, Strelitz Diabetes and Endocrine Disorders Institute, Department of Internal Medicine, Eastern Virginia Medical School

Romesh Khardori, MD, PhD, FACP is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Physicians, American Diabetes Association, and Endocrine Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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. Ozdemir MA, Karakukcu M, Per H, Unal E, Gumus H, Patiroglu T. Late-type vitamin K deficiency bleeding: experience from 120 patients. Childs Nerv Syst. Sep 18 2011;[Medline].

  9. Takahashi D, Shirahata A, Itoh S, Takahashi Y, Nishiguchi T, Matsuda Y. Vitamin K prophylaxis and Late Vitamin K deficiency bleeding in infants: The 5th nation-wide survey in Japan. Pediatr Int. Apr 22 2011;[Medline].

  10. 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.

  11. Nakajima S, Iijima H, Egawa S, Shinzaki S, Kondo J, Inoue T, et al. Association of vitamin K deficiency with bone metabolism and clinical disease activity in inflammatory bowel disease. Nutrition. Oct 2011;27(10):1023-8. [Medline].

  12. Vermeer C, Theuwissen E. Vitamin K, osteoporosis and degenerative diseases of ageing. Menopause Int. Mar 2011;17(1):19-23. [Medline].

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

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

  15. 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].

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

  17. 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].

  18. 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].

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

 
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