Our February, 2019 Quick Question was a case study entitled, “41-YO Man with GI Bleeding” (click or tap to review). For 56 responders, the answers and tallies were…
- Vitamin K deficiency 9% (5)
- Moderate liver disease 57% (32)
- Functional platelet disorder 4% (2)
- Disseminated intravascular coagulation 21% (12)
- Other: please provide a written response 9% (5)
There was one written response, Tanja Antunovic suggests liver cirrhosis, which George arbitrarily classifies as liver disease.
Given the patient’s history, liver disease is a reasonable diagnosis, though vitamin K deficiency is also a possibility. The laboratory director can support liver disease over vitamin K deficiency by performing a factor V assay, as factor V is not vitamin K-dependent, and would be normal in uncomplicated vitamin K deficiency. It is difficult to distinguish liver disease from DIC, particularly if thrombocytopenia is present. However, there is no notation of shistocytes in the periperal blood film examination, and the D-dimer is likely to be markedly increased. To diagnose a functional platelet disorder independent of liver disease, the laboratory scientist should confirm with platelet aggregometry.