ACQUIRED PROTHROMBIN COMPLEX DEFICIENCY Acquired prothrombin complex deficiency: A rare disorder where infants with a deficiency of vitamin

K suffer problems with bleeding. It is believed to occur in breast fed infants where the milk from the mother lacks sufficient vitamin K. low.

Causes Vitamin K deficiency is common among neonates in the first few days postpartum due to poor placental transfer of vitamin K and inadequate production of vitamin K-producing intestinal flora. Its other causes include prolonged use of drugs, such as the anticoagulant warfarin and antibiotics that destroy normal intestinal bacteria; decreased flow of bile to the small intestine from obstruction of the bile duct or bile fistula; malabsorption of vitamin K due to sprue, pellagra, bowel resection, ileitis, or ulcerative colitis; chronic hepatic disease, with impaired response of hepatic ribosomes to vitamin K; and cystic fibrosis, with fat malabsorption. Vitamin K deficiency seldom results from insufficient dietary intake of this vitamin.

Signs and symptoms The cardinal sign of vitamin K deficiency is an abnormal bleeding tendency, accompanied by prolonged prothrombin time (PT); these signs disappear with vitamin K administration. Without treatment, bleeding may be severe and, possibly, fatal.

Diagnosis Confirming diagnosis A PT that s 25% longer than the normal range of 10 to 20 seconds, measured by the Quick method, confirms the diagnosis of vitamin K deficiency after other causes of prolonged PT (such as anticoagulant therapy or hepatic disease) have been ruled out. The International Normalized Ratio (normal value, 0.8 to 1.2) is the more common method of assessing PT adequacy.

Repetition of testing in 24 hours (and regularly during treatment) monitors the therapy s effectiveness.

Treatment Administration of vitamin K I.V. or I.M. corrects abnormal bleeding tendencies.

Special Considerations To prevent vitamin K deficiency:

Administer vitamin K to neonates and patients with fat malabsorption or with prolonged diarrhea due to colitis, ileitis, or long-term antibiotic drug therapy.

Warn against self-medication with or overuse of antibiotics, because these drugs destroy the intestinal bacteria necessary to generate significant amounts of vitamin K.

If the deficiency has a dietary cause, help the patient and his family plan a diet that includes important sources of vitamin K, such as cauliflower, tomatoes, cheese, egg yolks, liver, and green, leafy vegetables.