Vitamin K
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Vitamin K is an essential, lipid-soluble vitamin that plays a vital role in the production of coagulation proteins.
The reference range of vitamin K is 0.2-3.2 ng/mL, but impaired blood clotting has been associated with levels below 0.5 ng/mL by one source. [1] Another source cites a reference range of 0.10-2.2 ng/mL. [2]
Conditions associated with vitamin K deficiency include the following: [3]
Hemorrhagic disease of newborn
Unexpected or excessive bleeding
Osteoporosis (conflicting data [4] )
Conditions that may lead to vitamin K deficiency include the following: [5, 3]
Chronic illness
Malnutrition
Multiple abdominal surgeries
Long-term parenteral nutrition
Malabsorption (cystic fibrosis, inflammatory bowel disease, cholestatic disease [biliary obstruction, primary biliary cirrhosis], celiac disease, chronic pancreatitis)
Parenchymal liver disease
Disseminated intravascular coagulation (DIC)
Conditions associated with excessive vitamin K include the following: [1]
Neonatal jaundice (with menadione [vitamin K3])
Hemolytic anemia (with menadione [vitamin K3])
Hyperbilirubinemia (with menadione [vitamin K3])
Blockage of oral anticoagulants
Specifics for collection and panels are as follows: [2, 6]
Specimen type: Blood serum or plasma
Container: Vacutainer, plain red-top (serum) or lavender-top EDTA (plasma)
Collection method: Venipuncture
Specimen volume: 2 mL
Rejected for hemolysis
Other instructions are as follows:
Spin down and submit frozen in amber vial
Fasting specimen
No alcohol consumption for 24 hours before collection
The following are related tests:
Prothrombin time (PT)
Activated partial thromboplastin time (aPTT)
Thrombin time
Platelet count
Platelet function tests
Coagulation factors
Fibrinogen
D-dimer
Vitamin K is an essential, lipid-soluble vitamin that plays a vital role in the production of coagulation proteins. There are 3 forms of vitamin K. Vitamin K1 (phylloquinone) is the natural form found in green leafy vegetables, green tea, and oils such as soybean, cottonseed, canola, and olive oil. [7] It is also the commercially available synthetic form used for treatment today. Vitamin K2 (menaquinone) is produced by colonic bacteria. Vitamin K3 (menadione) was a commercially available water-soluble form, it is no longer available for use in humans because of toxicity. [1]
Vitamin K serves as a cofactor in the carboxylation of certain glutamic acid residues on precursor coagulation proteins. The carboxylation enables binding of these proteins to surface phospholipids to start the normal antithrombotic process. Osteocalcin, which is secreted by osteoblasts and plays a role in bone formation, undergoes vitamin K–dependent carboxylation in a similar fashion. [4, 8]
Vitamin K deficiency may affect any age group but is encountered most often in infancy. Infants with vitamin K deficiency—which may be caused by the limited transplacental transfer of vitamin K, the low level of vitamin K in breast milk, limited neonatal liver vitamin K storage, and low neonatal colonic bacterial colonization—are at risk for hemorrhagic disease of newborn. Newborns in the United States, Canada, and Great Britain are routinely given vitamin K to prevent this. [4, 9, 10]
Vitamin K toxicity is typically associated with formula or synthetic vitamin K3 (menadione) injections. Because of its toxicity, menadione is no longer used for treatment of vitamin K deficiency. [4]
Measurement of vitamin K is unusual because the level responds to dietary changes within 24 hours, but effects on the vitamin K–dependent proteins are delayed. If vitamin K deficiency is suspected in a patient with unexpected or excessive bleeding, PT is the main laboratory test indicated. If the PT is prolonged in such a patient, vitamin K is often administered. Cessation of bleeding and normalization of the PT after vitamin K administration is presumptive evidence of vitamin K deficiency. [1]
Drugs that may cause vitamin K deficiency include the following: [1]
Antibiotics (cephalosporins)
Warfarin
Salicylates
Anticonvulsants
Sulfa drugs
High doses of vitamins A and E
Bile acid sequestrants (cholestyramine, colestipol), mineral oils, and orlistat weight-loss medication (may decrease absorption of vitamin K)
Vitamin K. Available at http://www.vitamin-basics.com/index.php?id=41. Accessed: April 5, 2012.
Vitamin K serum. Available at http://webserver01.bjc.org/labtestguide/VitKSer.htm. Accessed: April 16, 2012.
Dieu-Thu Nguyen-Kho, MD. Vitamin K Deficiency. Medscape Reference: Drugs, Diseases & Procedures. Available at http://emedicine.medscape.com/article/126354-overview. Accessed: April 5, 2012.
Vitmin K. Available at http://lpi.oregonstate.edu/infocenter/vitamins/vitaminK. Accessed: April 10. 2012.
Vitamin K. Available at http://umm.edu/altmed/arthicles/vitamin-k-000343.htm. Accessed: April 10. 2012.
Vitamin K1, Serum. Mayo Clinic, Mayo Medical Libraries. Available at http://www.mayomedicallaboratories.com/test-catalog/Specimen/91226. Accessed: April 16, 2012.
Vitamin K. Medline Plus. Available at http://www.nlm.nih.gov/medlineplus/ency/article/002407.htm. Accessed: April 10. 2012.
Pottegard A, Meegaard PM, Holck LH, Christensen Rd, Madsen H, Hallas J. Concurrent use of tramadol and oral vitamin K antagonists and the risk of excessive anticoagulation: a register-based nested case-control study. Eur J Clin Pharmacol. 2013 Mar. 69(3):641-6. [Medline].
Sahni V, Lai FY, MacDonald SE. Neonatal vitamin k refusal and nonimmunization. Pediatrics. 2014 Sep. 134(3):497-503. [Medline].
Seguna R, Maw KZ, Lyall HD, Bowles KM. “Haemorrhagic disease of the newborn” 89 years later than expected: vitamin K deficiency bleeding. Lancet. 2014 Aug 9. 384(9942):556. [Medline].
Vitamin k1. Medscape Reference: Drugs, Diseases & Procedures. Available at http://reference.medscape.com/drug/vitamin-k-mephyton-vitamin-k1-phytonadione-344424. Accessed: April 10. 2012.
Carl M Kraemer, MD, FAAEM, FACEP Assistant Director of Clinical Services, Department of Emergency Medicine; Assistant Professor of Surgery, Department of Surgery, Emergency Medicine Division, St Louis University School of Medicine
Carl M Kraemer, MD, FAAEM, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Association
Disclosure: Nothing to disclose.
Eric B Staros, MD Associate Professor of Pathology, St Louis University School of Medicine; Director of Clinical Laboratories, Director of Cytopathology, Department of Pathology, St Louis University Hospital
Eric B Staros, MD is a member of the following medical societies: American Medical Association, American Society for Clinical Pathology, College of American Pathologists, Association for Molecular Pathology
Disclosure: Nothing to disclose.
Judy Lin, MD
Disclosure: Nothing to disclose.
Vitamin K
Research & References of Vitamin K |A&C Accounting And Tax Services
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