Quick Question: 41 YO Man With GI Bleeding Response

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…

1. Vitamin K deficiency 9% (5)
2. Moderate liver disease 57% (32)
3. Functional platelet disorder 4% (2)
4. Disseminated intravascular coagulation 21% (12)
5. 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.