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A study of the prevalence of vitamin K deficiency in patients with cancer referred to a hospital palliative care team and its association with abnormal haemostasis
  1. Dominic Jon Harrington (domonic.harrington{at}gstt.nhs.uk)
  1. Guy's and St. Thomas' NHS Foundation Trust, United Kingdom
    1. Hannah Western
    1. Guy's and St. Thomas' NHS Foundation Trust, United Kingdom
      1. Cate Seton-Jones
      1. Guy's and St. Thomas' NHS Foundation Trust, United Kingdom
        1. Savita Rangarajan
        1. Guy's and St. Thomas' NHS Foundation Trust, United Kingdom
          1. Teresa Beynon
          1. Guy's and St. Thomas' NHS Foundation Trust, United Kingdom
            1. Martin John Shearer (martin.shearer{at}gstt.nhs.uk)
            1. Guy's and St. Thomas' NHS Foundation Trust, United Kingdom

              Abstract

              Aim: Many patients with advanced cancer are malnourished. Anorexia is common, as is the use of chemotherapy, which may cause nausea and poor appetite. 10% of these patients experience haemorrhagic events. Since vitamin K deficiency (VKD) causes bleeding, we established the prevalence of VKD in patients with advanced cancer receiving palliative care. Methods: We determined the serum concentration of vitamin K1 and undercarboxylated factor II (PIVKA-II) in 46 (17 male/29 female) inpatients aged (mean) 26-85 (58) years. INR and liver function tests (bilirubin, ALT, GGT and ALP) were also performed. Results: Vitamin K1 was below the lower limit of the reference range (0.33 nmol/L) in 22% of patients. 78% of patients had some degree of functional VKD indicated by raised ( > 0.2 AU/mL) PIVKA-II. Six patients (13%) had a prolonged INR, all of whom had raised PIVKA-II and GGT levels, and 4 also had a vitamin K1 concentration < 0.33 nmol/L. Three patients (6.5%) had clinically significant VKD characterized by an INR > 1.5, a PIVKA-II > 10 AU/mL, and undetectable vitamin K1. Conclusions: Patients with advanced cancer are prone to VKD which while usually subclinical may develop to a clinically relevant prolongation of the INR. Serum measurements of vitamin K1 and PIVKA-II can be used to detect VKD and monitor vitamin K status before an increased risk of bleeding develops.

              • Deficiency
              • INR
              • PIVKA-II
              • Palliative care
              • Vitamin K

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