History

Patients with a factor II deficiency may report a family history of bleeding disorders. They may also report a personal history of the following:

Umbilical cord stump bleeding at birth
Prolonged bleeding following circumcision
Postpartum bleeding
Easy bruising
Bleeding gums
Epistaxis
Menorrhagia
Prolonged postsurgical bleeding
Melena
Hematuria
Hemarthroses
Soft-tissue hemorrhages
Intracranial bleeding

Physical

The physical examination of a patient with factor II deficiency may reveal petechiae and/or ecchymoses, which commonly develop in areas of minor trauma. Ambulatory patients may have petechiae or ecchymoses in the ankle area, whereas bedridden patients may have them on the back. Petechiae may develop following blood pressure measurements in the area beneath the cuff. Additionally, patients may ooze from venipuncture sites. Patients with active hemorrhage may also be seen in emergency departments.

In the case of acquired factor II deficiency, physical examination may reveal signs of underlying liver disease or gastrointestinal malabsorption.

Causes

See the list below:

Inherited factor II deficiency is an autosomal recessive disorder.
The most common causes of acquired factor II deficiency include severe liver disease, vitamin K deficiency, or vitamin K antagonist administration (eg, warfarin).
Hereditary thrombosis associated with antithrombin resistance may result from a mutation in the gene encoding prothrombin.^[46]This novel gain-of-function mutation in the prothrombin gene results in resistance to antithrombin and susceptibility to thrombosis.

Differential Diagnoses

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Author

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Professor of Pediatrics, Professor of Medicine, Rutgers New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, New York Academy of Medicine, Royal College of Physicians of Edinburgh, Sigma Xi, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Coauthor(s)

Christopher J Steen, MD Dermatologist, Private Practice

Christopher J Steen, MD is a member of the following medical societies: Alpha Omega Alpha, Sigma Xi, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Pere Gascon, MD, PhD Professor and Senior Consultant, Division of Medical Oncology, Institute of Hematology and Medical Oncology, Hospital Clinic; Director, Laboratory of Molecular and Translational Oncology, University of Barcelona Faculty of Biology, Spain

Pere Gascon, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, New York Academy of Medicine, New York Academy of Sciences, Royal College of Surgeons of Edinburgh, Royal European Academy of Doctors, Sigma Xi, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

Ronald A Sacher, MD, FRCPC, DTM&H Professor Emeritus of Internal Medicine and Hematology/Oncology, Emeritus Director, Hoxworth Blood Center, University of Cincinnati Academic Health Center

Ronald A Sacher, MD, FRCPC, DTM&H is a member of the following medical societies: American Association for the Advancement of Science, American Association of Blood Banks, American Clinical and Climatological Association, American Society for Clinical Pathology, American Society of Hematology, College of American Pathologists, International Society of Blood Transfusion, International Society on Thrombosis and Haemostasis, Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Chief Editor

Perumal Thiagarajan, MD Professor, Department of Pathology and Medicine, Baylor College of Medicine; Director, Transfusion Medicine and Hematology Laboratory, Michael E DeBakey Veterans Affairs Medical Center

Perumal Thiagarajan, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Society for Biochemistry and Molecular Biology, American Society for Clinical Investigation, American Society of Hematology, Association of American Physicians, Royal College of Physicians

Disclosure: Nothing to disclose.

Additional Contributors

Paul Schick, MD † Emeritus Professor, Department of Internal Medicine, Jefferson Medical College of Thomas Jefferson University; Research Professor, Department of Internal Medicine, Drexel University College of Medicine; Adjunct Professor of Medicine, Lankenau Hospital

Paul Schick, MD is a member of the following medical societies: American College of Physicians, American Society of Hematology

Disclosure: Nothing to disclose.

Sections Factor II Deficiency
Overview
Presentation
- History
- Physical
- Causes
- Show All
DDx
Workup
Treatment
Medication
Follow-up
References

Factor II Deficiency Clinical Presentation

History

Physical

Causes

References

Tables

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