We report a case of absolute
vitamin K deficiency (VKD) diagnosed by measuring serum VK levels in an elderly woman undergoing
warfarin therapy. A 78-year-old woman was admitted to our hospital because of
dyspnea and
sore throat diagnosed as
pharyngitis 1 week before admission. On admission, the
sore throat had exacerbated and
dyspnea developed. She had history of
atrial fibrillation, for which
warfarin 1.5 mg/d was started approximately 10 years prior and her international normalized ratio (INR) had been maintained at an acceptable therapeutic level. Blood results revealed unmeasurable INR and abnormally prolonged activated partial thromboplastin time (APTT). She was diagnosed with adenoiditis and
warfarin-related coagulopathy and administered intravenous VK (20 mg) and fresh frozen plasma (FFP; 4 U), which improved INR and APTT. Since the coagulopathy responded to intravenous VK administration, the patient was clinically diagnosed with
warfarin-related relative VKD. Approximately 1 month later, she returned with complaints of
sore throat. Blood results indicated abnormal INR (7.22) and APTT (N80.0 s). She was diagnosed with recurrent adenoiditis and VK deficient coagulopathy. The patient’s serum VK levels were low (VK1 level, 0.13 ng/mL; VK2 levels, 0.85 ng/mL). Initial treatment of VK (20 mg) and FFP followed by intravenous VK (20 mg/d) for 6 days, her symptoms dissipated.
Warfarin was suspected to have caused absolute VKD. Severe coagulopathy in patients undergoing
warfarin therapy is primarily caused by, relative VKD. However, the possibility of
warfarin-related absolute VKD should be suspected when INRis not sufficiently improved by intravenous VK administration.