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Which coagulation cofactor would most likely be deficient first in this patient?

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asked Apr 28, 2017 in Medicine by Rajesh Bahara
60-year-old man with recurrent bacterial sepsis is hospitalized in order to receive intravenous antibiotics. He is started on his fourth course of broad-spectrum antibiotics within the past month. Three days into the admission, his nurse notes that his venous access is oozing blood. Laboratory tests reveal a prolonged prothrombin time, a prolonged partial thromboplastin time, and a normal platelet count. Which of the following coagulation cofactors would most likely be deficient first in this patient?
(A) Factor II
(B) Factor V
(C) Factor VII
(D) Factor VIII
(E) Factor XI
(F) Factor XII

1 Answer

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Best answer
The correct answer is (C) Factor VII

Vitamin K is synthesized by the intestinal flora; therefore long- term treatment with broad-spectrum antibiotics can induce a vitamin K deficiency by clearing intestinal flora. Vitamin K is a necessary cofactor for hepatic production of clotting factors II, VII, IX, and X and proteins C and S. Factor VII has the shortest half-life of all clotting factors (4–6 hours), which is why the prothrombin time is prolonged first in vitamin K deficiency.

Answer A is incorrect. Factor II requires vita- min K as a cofactor, and early factor II deficiency would result in prolongation of pro- thrombin time and partial thromboplastin time. However, the half-life of factor II is 42– 72 hours, and thus it would not be deficient before factor VII is deficient.

Answer B is incorrect. Vitamin K is not required for factor V synthesis and would not be deficient in this patient.

Answer D is incorrect. Factor VIII is not a vitamin K dependent clotting factor.

Answer E is incorrect. Factor XI is not a vitamin K dependent clotting factor.

Answer F is incorrect. Factor XII is not a vitamin K dependent clotting factor.
answered Apr 28, 2017 by Rajesh Bahara

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