overview, types of vitamin k, symptoms, cause, diagnosis, managment , prevention , diagnosis

2. VITAMIN K DEFICIENCY
PRESENTED BY
Dr. Qureshi Jalib

3.  Vitamin K is a nutrient that the body requires in small, regular
amounts. It is essential for the formation of several substances
called coagulation factors that work together to clot the blood
when injuries to blood vessels occur.
 Insufficient vitamin K can lead to excessive bleeding and easy
bruising. Vitamin K is also thought to play an important role in
the prevention of bone loss.
 Low blood levels of vitamin K have been associated with low
bone density, and there is some evidence that adequate levels of
vitamin K can improve bone health while reducing the risk of
fractures.
INTRODUCTION
Cont.…..

4.  Vitamin k is a fat soluble vitamin necessary for the
synthesis(activation) of clotting factors :
 Clotting factor II (prothrombin)
 Clotting factor VII (proconvertin)
 Clotting factor IX (thromboplastin)
 Clotting factor X (Stuart factor)

5.  Vitamin K1 (phylloquinone or phytomenadione)
 Vitamin K2 (menaquinones)
 Vitamin k3 (Menadione)
TYPES OF VITAMIN K

6.  Vitamin K1 (phylloquinone or phytomenadione) is the
natural from of vitamin K that comes from foods,
especially green leafy vegetables but also dairy products
and vegetable oils.
 K1 is considered as the "plant form" of vitamin K, but it is
also produced commercially to treat some conditions
associated with excess bleeding.

7.  Vitamin K2 (menaquinones) is made by bacteria,
the normal flora in the intestines. Bacteria in the intestines
can also convert K1 into K2.
 Vitamin K2 supplements K1 from the diet to meet the
body's requirements.
 Menaquinone is also present in animal origin foods like:
Meat especially liver
Cheese

8.  Menadione is a non-natural, man-made chemical
compound that is used in some countries as a nutritional
supplement because of its vitamin K activity. It is
sometimes called K3.
 Menadione supplements are currently banned in the U.S.
because of its potential toxicity in human use.

10. PHYSIOLOGY
 Vitamin K (VK) acts as a cofactor; it is needed for the conversion of 10-
12 glutamic acid residue on the NH2 -terminal of precursor
coagulation proteins into the action form of gamma-carboxyglutamic
acid (which occurs via VK-dependent gamma-glutamyl carboxylase).
 This essential reaction allows the VK-dependent proteins to bind to
surface phospholipids through calcium ion channel–mediated
binding, in order to start the normal antithrombotic process. The exact
mechanism by which VK functions as cofactor with the carboxylase is
not fully understood.
 Vitamin K is required in the synthesis of 4 clotting factors in the liver:
factors II,VII, IX, and X. It is also essential in the production of protein
C and S, which are anticoagulant proteins.
 Bone matrix proteins, specifically osteocalcin, undergo gamma
carboxylation with calcium much the way coagulation factors do; this
process also requires VK.

11. Vitamin k deficiency
 Vitamin K deficiency bleeding (VKDB) is a bleeding
problem that occurs in some newborns during the first few
days of life. VKDB was previously called hemorrhagic
disease of the newborn.

12.  Vitamin K (VK) deficiency can occur in any age group, but
it is encountered most often in infancy.
 In infants, VK deficiency without bleeding may occur in as
many as 50% of infants younger than 5 days.
 The classic hemorrhagic disease occurs in 0.25-1.7% of
infants.
 The prevalence of late hemorrhagic disease in breastfed
infants is about 20 cases per 100,000 live births with no
prior VK prophylaxis.
EPIDEMIOLOGY

13. SIGNS AND SYMPTOMS
 The signs and symptoms associated with vitamin K
deficiency may include:
 Easy bruising
 Oozing from nose or gums
 Excessive bleeding from wounds, punctures, and injection or
surgical sites
 Heavy menstrual periods
 Bleeding from the gastrointestinal (GI) tract
 Blood in the urine and/or stool
 Increased prothrombin time (PT)

14.  In hemorrhagic disease of the newborn, in more serious
cases, may also involve bleeding within the skull
(intracranial).

15.  The most common causes of vitamin K deficiency are insufficient
dietary intake, inadequate absorption, and decreased storage of the
vitamin due to liver disease, but it may also be caused by decreased
production in the intestines.
 Although vitamin K deficiency is uncommon in adults, certain people
are at increased risk if they:
 take coumarin anticoagulants such as warfarin, which thins the blood
 are taking antibiotics
 have a condition that causes the body to not absorb fat properly (fat
malabsorption)
 have a diet that is extremely lacking in vitamin K
CAUSES
Cont.…..

16.  Coumarin anticoagulants interfere with the production of the
proteins involved in blood clotting.
 Some antibiotics cause the body to produce less of its own vitamin
K. Other antibiotics may cause vitamin K to become less effective in
the body.
 Fat malabsorption leading to vitamin K deficiency may occur in
people with:
 celiac disease
 cystic fibrosis
 a disorder in the intestines or biliary tract (liver, gallbladder, and
bile ducts)
 part of their intestine removed
Cont.…..

17.  Newborn infants are at increased risk for vitamin K
deficiency for a variety of reasons:
 breast milk is very low in vitamin K
 vitamin K does not transfer well from a mother’s placenta to
her baby
 the liver of a newborn infant doesn’t use the vitamin
efficiently
 newborns don’t produce vitamin K2 on their own in the first
few days of life

18.  Physical exam
 The exam is often unremarkable. In severe cases, the
individual may be weak and pale due to loss of blood.
 Physical findings may reveal small hemorrhagic spots in the
skin (petechial), a localized collection of blood (hematoma),
or oozing of blood from a puncture site.
 Bruising is common. Infants may have an underdeveloped
face, nose, or bones.
DIAGNOSIS
Cont.….

19.  Tests
 Prothrombin time
 thrombin time
 platelet count
 platelet function tests
 coagulation factor tests
 fibrinogen
Cont.….

20.  A deficiency of vitamin K is usually discovered when
unexpected or excessive bleeding occurs.
 In such cases, a prothrombin time (PT) laboratory test is
performed to investigate the bleeding. If the result is
prolonged and is suspected to be due to low levels of
vitamin K, then vitamin K will often be given by injection.
 If the bleeding stops and the PT returns to normal, then a
vitamin K deficiency is assumed to be the cause.

21.  Short-term treatment for vitamin K deficiency usually
involves either oral supplementation or injections.
 Long-term or lifetime supplementation may be
necessary for those with underlying chronic conditions.
The action of vitamin K typically requires 2 to 5 days
after it is given to show treatment effect.
TREATMENT
Cont.….

22.  The medical therapy for vitamin K (VK) deficiency
depends on the severity of the associated bleeding and
the underlying disease state.
 The most effective approach to correcting the deficiency
also depends on the nature of the bleeding and the risk
of inducing a local hematoma at the VK injection site.
 In life-threatening bleeds, fresh frozen plasma should be
administered prior to VK.
Cont.….

23.  The treatment for vitamin K is the drug phytonadione
which is vitamin K1.
 Dosage
 adults ranges from 1 to 25 milligrams
 taking an anticoagulant 1 to 10 mg.
 newborns get a single shot of 0.5 to 1 mg vitamin K1 at birth.
 A higher dose may be necessary if the mother has been
taking anticoagulants or anti-seizure drugs.
Cont.….

24.  Vitamin K-dependent clotting factors are produced by
the liver.
 If a person has chronic liver disease that person may
not be able to produce sufficient clotting factors even
when adequate vitamin K is available.
 Vitamin K supplementation may not be effective in
those with seriously damaged livers.
Cont.….

25.  If there is a high risk for hematoma formation with intramuscular
or subcutaneous VK administration, then an oral form of VK can
be administered in 5- to 20-mg doses, depending on the severity.
 In urgent situations, 10-20 mg of injectable phytonadione (VK-1)
can be dissolved in a 5% dextrose or 0.9% normal saline to be
administered intravenously at a rate not to exceed 1 mg/mL to
prevent a hypersensitive or anaphylactic reaction.
 When giving VK in the intravenous form, the patient needs to be
monitored closely, because cardiopulmonary arrest and/or shock
can occur in rare cases. The parenteral administration of VK-1
corrects VK deficiency in 12-24 hours.

26.  On an average day, nutritionists consider ;
 120 mg adequate for men
 90 mg adequate for women.
 Some foods, including leafy green vegetables, are extremely high
in vitamin K and will give you all you need in one serving.
 A single shot of vitamin K at birth can prevent a problem in
newborns.
 People with conditions involving fat malabsorption, taking
warfarin and similar anticoagulants should speak to their
doctors about taking a vitamin K supplement and having their
levels monitored.
PREVENTION

27.  Patients with VK deficiency have a very good prognosis if the
condition is recognized early and treated appropriately.
 No mortalities from VK deficiency have been reported. However,
severe bleeding can occur if the deficiency is left untreated.
 Morbidity correlates with the severity of vitamin K deficiency. The
risk of developing vitamin K deficiency bleeding is 81 times greater
in infants who do not receive a prophylactic vitamin K injection.
 In 50% of patients with late vitamin K deficiency bleeding (VKDB),
the bleeding location involves an intracranial hemorrhage, which is
associated with high mortality and morbidity.
PROGNOSIS

28.  https://labtestsonline.org/understanding/conditions/vita
mink/start/4
 http://www.healthline.com/health/vitamin-k-
deficiency#prevention7
 http://emedicine.medscape.com/article/126354-treatment
 http://www.stanfordchildrens.org/en/topic/default?id=vit
amin-k-deficiency-bleeding-hemorrhagic-disease-of-the-
newborn-90-P02372
REFERENCES