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Quick Question: Liver Disease or VK Deficiency?

Here are the results to our October, 2019 Quick Question, “What factor assays do you perform to distinguish liver disease from vitamin K deficiency?”

a. II and V: 13 (15%)
b. V and X: 10 (12%)
c. II and X: 8 (9%)
d. V and VII: 44 (51%)
e. VII and X: 11 (13%)

The key to this approach is to differentiate among vitamin K-dependent and non-vitamin K-dependent coagulation factors. The vitamin K-dependent factors are II, VII, IX, and X (as well as coagulation control factors C, S, and Z), and the only non-VK-dependent factor among our answers is factor V. So either answers b and d could be correct, however a majority of us select d, V and VII, because factor VII has a 6-hour half life and the smallest plasma concentration of all the factors at 0.05 mg/dL. Owing to VII’s half-life and plasma concentration, it is the factor most likely to become deficient early in VK deficiency. In liver disease, both V and VII become depleted because both factors are produced by the liver.

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