Factor X Deficiency Clinical Presentation

Updated: Feb 16, 2021
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Perumal Thiagarajan, MD  more...
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Patients with factor X deficiency may report a family history of a bleeding disorder. Possible symptoms include the following:

  • Severe umbilical cord stump bleeding
  • Prolonged bleeding following circumcision
  • Recurring nose bleeds
  • Easy bruising
  • Hematuria
  • Menorrhagia at menarche (single case report) [45]
  • Spontaneous abortion in the first trimester
  • Excessive bleeding during or following surgery or trauma
  • Pseudotumors
  • Intracranial bleeding
  • Hemarthroses (in severe deficiency)
  • Bleeding in soft tissues, muscles, and gut


The physical examination of a patient with factor X deficiency may reveal petechiae, ecchymoses, or both, 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.

Central nervous system hematomas may occur in infants and children, including bilateral chronic subdural hematoma. [46]

In cases of acquired factor X deficiency, the physical examination may reveal signs of underlying disease, such as the following:

  • Liver disease
  • Intestinal malabsorption
  • Upper respiratory tract infection
  • Amyloidosis
  • Leprosy


Factor X deficiency may be hereditary or acquired. Congenital factor X deficiency is an autosomal recessive disorder.

The most common causes of acquired factor X deficiency include the following:

  • Liver disease
  • Vitamin K deficiency
  • Vitamin K antagonist use
  • Amyloidosis
  • Neoplasm


Women with congenital factor X deficiency are at increased risk of the following [47] :

  • Heavy menstrual bleeding
  • Recurrent ovulation bleeding with hemoperitoneum
  • Bleeding complications in pregnancy (eg, retroplacental hematoma, postpartum hemorrhage)