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									Unknown #35
   A 38 year old woman presents with multiple leg
    bruises. She has a history of recurrent cellulitis and
    folliculitis, most recently treated 3 days ago.
   She recently tested positive for nasal staph carriage,
    and was told to use nasal bactroban to eradicate the
    carrier state.
   On ROS, she states she has sometimes seen reddish
    urine. The rest of the history is negative. She is
    nulliparous.
   On exam, she has a few splinter hemorrhages on her
    fingernails, and a large ecchymosis on her left thigh.
   Labs show a WBC of 5.5, Hb of 12%, platelet count
    of 178K, PT 19.2, PTT 74, ANA is positive at 1:80
    with a speckled pattern.
   What treatment is most likely to improve this
    patient’s hematologic abnormality?

       A) Vitamin K supplementation
       B) Immunosuppressive therapy for Systemic Lupus with
        lupus anticoagulant
       C) Antibiotics for presumed culture-negative endocarditis
       D) Cryoprecipitate
       E) Anticoagulation with low-molecular weight heparin
   What treatment is most likely to improve this
    patient’s hematologic abnormality?

       A) Vitamin K supplementation
       B) Immunosuppressive therapy for Systemic Lupus with
        lupus anticoagulant
       C) Antibiotics for presumed culture-negative endocarditis
       D) Cryoprecipitate
       E) Anticoagulation with low-molecular weight heparin
               Vitamin K deficiency
   Common in newborns (immature liver)
   Uncommon in adults
   Causes:
       Dietary deficiency (very rare)
       Acquired:
            Antibiotics – gut bacteria synthesize absorbable Vitamin
             K (menaquinone) [patient had widespread antibiotic use]
            Short bowel syndrome
             Vitamin K deficiency
   Clinical manifestations:
       easy bruisability
       mucosal bleeding
       splinter hemorrhages
       melena
       hematuria
       other manifestations of impaired coagulation
               Vitamin K deficiency
   Laboratory manifestations:
       Prolonged PT and aPTT
       Remember pathways:
            II (common)
            VII (extrinsic)
            IX (intrinsic)
            X (common)
            These, as well as Protein C and S, are “Vitamin K
             dependent”
             Vitamin K deficiency
   Treatment
       Mainly oral vitamin K, up to 25 mg
       IM or SC may be used for those with GI
        absorptive problems or cannot take p.o.
       IV only in severe cases (anaphylaxis)


     OBJECTIVE: Recognize the clinical features of coagulopathy
     due to Vitamin K deficiency

								
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