From the Guidelines
Vitamin K1 (phylloquinone) deficiency primarily manifests as bleeding disorders due to impaired blood clotting, with symptoms including easy bruising, nosebleeds, bleeding gums, and prolonged bleeding after surgery or injury, as supported by studies such as 1 and 1. The most common symptoms of vitamin K1 deficiency include:
- Easy bruising
- Nosebleeds
- Bleeding gums
- Blood in urine or stool
- Excessive bleeding from cuts or wounds
- Prolonged bleeding after surgery or injury In severe cases, patients may experience internal bleeding, including gastrointestinal bleeding or intracranial hemorrhage, which can be life-threatening, as noted in 1. Women might notice heavier menstrual periods, and newborns with vitamin K deficiency can develop vitamin K deficiency bleeding (VKDB), which may cause bleeding into the brain. Vitamin K1 is essential for activating clotting factors II, VII, IX, and X in the liver, as well as proteins C and S that regulate clotting, as discussed in 1 and 1. Without sufficient vitamin K1, these proteins remain inactive, leading to prolonged clotting times and increased bleeding risk. Deficiency is rare in healthy adults with normal diets but more common in those with malabsorption disorders, those taking certain antibiotics, or individuals on long-term parenteral nutrition, as highlighted in 1 and 1. Treatment typically involves vitamin K1 supplementation, with dosages varying based on severity and underlying cause, such as the recommendations outlined in 1 and 1.
From the Research
Symptoms of Vitamin K1 Deficiency
The symptoms of vitamin K1 (phylloquinone) deficiency can be identified through various studies, including:
- Generalized bleeding tendency 2
- Noncarboxylated prothrombin (PIVKA-II) determinations, which are a sensitive indicator of vitamin K deficiency 2
- Abnormal clotting tests, including prolongation of the APTT, PT, and thrombotest 2
- Bleeding and ecchymosis 3
- Convulsions 3
- Feeding intolerance, poor sucking, and vomiting 3
- Diarrhea 3
- Jaundice 3
- Pallor 3
- Intracranial bleeding, including subdural, intracerebral, subarachnoid, intraventricular, and combination of these 3
Diagnosis and Management
Diagnosing vitamin K1 deficiency can be challenging due to the different forms and half-lives of vitamin K isoforms 4. However, patients with suspected vitamin K1 deficiency-related coagulopathies can be assessed for coagulopathy correction within 1-2 days after receiving vitamin K, either orally or parenterally 4. Vitamin K1 deficiency can be prevented by providing vitamin K prophylaxis to all newborns, and administration of vitamin K (1 mg) at birth can prevent intracranial bleeding and other hemorrhagic manifestations 3.
Risk Factors
Vitamin K1 deficiency can occur at any age, and risk factors include: