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As a doctor today I prescribe Vitamin K to prevent hemorrhage.

Dr Sampurna Roy MD     

The most important health problem of Vitamin K deficiency is Hemorrhagic Disease of the Newborn.

 

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Vitamin K was named from Danish word Koagulation-Vitamin.

This Vitamin was discovered by Carl Peter Henrik Dam in 1934 as a result of careful study of a hemorrhagic disease that he observed in chickens.

Vitamin K was isolated in 1939 by Dam and Paul Karrer in Zurich and the structure was determined by Edward Adelbert Doisy. 

Vitamin K Vitamin K (phylloquinone, K1; menaquinone, K2)  is necessary for the formation of Prothrombin (factor II) and three other coagulation factors, VII, IX and X in the liver.

Vitamin K Deficiency               

- Vitamin K deficiency results in a depletion of liver stores of phylloquinone,

- Decreased plasma levels of vitamin K1,

- Increased levels of K1 epoxide,

- Appearance of noncarboxylated protein (PIVKA),

- Decreased levels of functioning vitamin K-dependent clotting factors and prolongation of the APTT, PT and thrombotest.

- When the progression of deficiency leads to abnormal clotting tests a generalized bleeding tendency occurs.

- Clinically vitamin K is great importance to prevent hemorrhagic disease of the newborn.

- In adults, simple deficiency is rare.

Adequate amounts are normally supplied in the average diet.

- Vitamin K  is formed by intestinal bacteria, which are absent for several days in newborn infants.

 

Vitamin K is found in leafy vegetables like spinach, cauliflower, cabbage and brocolli and cereals.

Four vegetable oils (soybean, cottonseed, canola and olive) contain high amounts of Vitamin K.

Foods of animal origin (including fish-liver oils) are poor sources unless they have undergone extensive bacterial putrefaction, with formation of one of the vitamin K2 series.

Primary Vitamin K deficiency occurring in the Newborn:

Hemorrhagic disease of the newborn is due to an exaggerated hypoprothrombinaemia which occurs 24-72 hours after birth when there is no bacteria in the gut which synthesize vitamin K. 

The deficiency is even more marked in premature babies.

Usually the plasma prothrombin returns to normal during the second week after birth.

A grave haemorrhagic state has been described in infants in whom the the plasma prothrombin falls to less than 1% of normal.

If Vitamin K is given complete recovery of blood may occur in less than 48 hours.

1 mg vitamin K1 with the first feed is a safe prophylactic measure against the development of hemorrhagic disease of the new-born.

There is bleeding from mouth, nose, umbilicus, gastrointestinal tract (rectum), urinary tract and intracranial hemorrhage. 

Easy and severe bruising of skin occurs.

Chronic diarrhoea.

The syndrome of Vitamin K deficiency has been reported in chronic diarrhoea.

The cause may be failure of absorption as a result of the altered state of the intestinal wall and the associated diarrhoea, or an abnormal state of intestinal bacteria leading to defective synthesis of the vitamin.

The syndrome may also occur with defective fat absorption in sprue.

 

Secondary vitamin K deficiency occurs in obstructive jaundice, malabsorption and in patients given prolonged courses of intestinal antibiotics.

In obstructive jaundice bile is excluded from the bowel due to obstruction somewhere in the biliary passages.

The absence of bile salts from the bowel prevent vitamin K absorption with the result that prothrombin and factor VII are decreased and clotting time may also be prolonged and hemorrhage may occur.

In untreated cases operative procedure procedures may involve death from uncontrollable bleeding.

The state of blood may be restored to normal by giving bile salts alone, bile salts plus vitamin K by mouth, or more rapidly by injecting vitamin K intramuscularly.

The coumarin anticoagulants owe their therapeutic action to interference with the role of vitamin K in synthesis of the clotting factors in the liver.

When anticoagulation is required, drugs, particularly warfarin, are used to alter the synthesis of factors II, VII, IX and X.

Proteins are produced which are antigenically similar to these factors but do not have their procoagulant properties.

Patients with simple vitamin K deficiency or overdose with oral anticoagulants are liable to excessive bruising, gastrointestinal hemorrhage, hematuria, epistaxis and excessive menstrual loss.

When deficiency is associated with severe liver disease the clinical and hemostatic problems are more complex because of the addition of other factor deficiencies, thrombocytopenia and toxic damage to the vasculature.  

 

Vitamin K deficiency can occur at any age (warfarin, fasting, antibiotic therapy, malabsorption syndromes).

Vitamin K may also play a role in the pathogenesis of Alzheimer's disease.

Vitamin K in the diet is necessary to regulate bone and cartilage mineralization.

It is required to maintain musculoskeletal health.

Subclinical vitamin K deficiency may be involved in the pathogenesis of osteoporosis and osteoarthritis.

The most important public health problem is related to prevention of hemorrhagic disease of the newborn.

 

 

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Visit: Eat Citrus Fruits everyday and keep Scurvy away - Pathology of Vitamin C Deficiency

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Further reading:

Vitamin K deficiency.

Supplementation of vitamin K in pregnant women receiving anticonvulsant therapy prevents neonatal vitamin K deficiency

Detection of vitamin K deficiency by use of an enzyme-linked immunosorbent assay for circulating abnormal prothrombin.

Increased incidence of neonatal vitamin K deficiency resulting from maternal anticonvulsant therapy

Vitamin K in infancy

The second nation-wide survey in Japan of vitamin K deficiency in infancy

Unexpected vitamin K deficiency in hospitalized patients

Prevention of vitamin K deficiency bleeding: efficacy of different multiple oral dose schedules of vitamin K

Vitamin K deficiency bleeding (VKDB) in infancy

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Dr  Sampurna Roy  MD

Consultant Histopathologist (Kolkata - India)

 

 


 

 

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