What is Vitamin K Deficiency?
Vitamin K is a type of nutrient that dissolves in fat. It helps with critical bodily processes, such as forming blood clots, maintaining bones, and supporting heart health. If you don’t get enough Vitamin K, you can face problems like serious bleeding, weak bone development, osteoporosis, and a higher risk of heart disease. For healthy adults, experts from the National Academy of Science Food and Nutrition Board suggest men should consume 120 micrograms per day and women should consume 90 micrograms per day.
Newborn babies can suffer from a condition called Vitamin K deficiency bleeding (VKDB), which can occur at different times. ‘Early VKDB’ shows up within 24 hours of birth, ‘classic VKDB’ within the first week, and ‘late VKDB’ between the first week and six months. Most cases of ‘late VKDB’ occur between two and eight weeks. There’s also a rare inherited blood disorder related to Vitamin K deficiency called ‘VKCFD’, which can cause bleeding in newborn babies.
What Causes Vitamin K Deficiency?
A lack of Vitamin K can result from several factors, such as not eating enough foods that are high in vitamin K. These include leafy green vegetables and fermented products. Some health problems, like celiac disease or inflammatory bowel diseases, can make it difficult for the body to absorb vitamin K. Long-term use of antibiotics can also disrupt the gut bacteria that help produce vitamin K. Certain medications, especially blood thinners, can hinder how vitamin K is used in the body. Understanding these factors can help prevent and manage a vitamin K deficiency effectively.
These factors might even influence the Vitamin K deficiency bleeding in newborns (VKDB), which could happen when a pregnant woman uses certain medications or if the baby has low vitamin K levels at birth or is exclusively breastfed.
On the other hand, there’s a rare genetic disorder known as VKCFD. This disorder decreases the amount of certain proteins in the body, like coagulation factors II, VII, IX, and X, as well as proteins C, S, and Z. These proteins help blood to clot, so their deficiency can lead to bleeding issues.
Risk Factors and Frequency for Vitamin K Deficiency
Vitamin K deficiency is seen in around 8% to 31% of healthy adults but it often doesn’t result in significant bleeding issues. This bleeding is usually seen in individuals with absorption issues, liver disease, or those taking certain medications that affect vitamin K.
Every newborn child naturally has lower vitamin K levels. A condition of bleeding that occurs 2 to 3 days after birth was first identified in 1894. If combined with infection-related bleeding, it resulted in as many as 600 cases in 100,000 infants, with a fatality rate of 62%. Mothers taking certain medications, including seizure medications, can make their infants at risk of this early vitamin K deficiency bleeding. Without newborn vitamin K treatment, the risk of the condition is as high as 12%.
- Without vitamin K treatment, traditional vitamin K deficiency bleeding might affect 0.25% to 1.7% of infants.
- Later-onset vitamin K deficiency occurs in 4.4 to 72 out of 100,000 babies, especially in infants who are exclusively breastfed or those of Asian descent.
- The death rate for late-onset deficiency can range from 20% to 50%.
- It also has a serious risk of neurological damage due to bleeding in the brain.
Finally, a rare condition called VKCFD affects both men and women equally and fewer than 30 cases have been reported worldwide – This disorder is caused by mutations in certain genes and is inherited in an autosomal recessive manner.
Signs and Symptoms of Vitamin K Deficiency
Vitamin K deficiency can lead to bleeding even from minor injuries or when blood is drawn for tests. Certain medications like antibiotics, seizure medications, warfarin, or other prescriptions can disrupt the body’s ability to utilize vitamin K properly. Physical check-up might reveal signs of bleeding under the skin, such as bruises or tiny red dots (petechiae).
Vitamin K deficiency bleeding (VKDB) is a condition primarily seen in newborns whose parents refused vitamin K shots recommended at birth. It might result in serious internal bleeding in the head, chest, or abdomen, especially if the mother took medications that impaired vitamin K metabolism. It’s less severe symptoms can include bleeding from the belly button, intestinal tract, or after circumcision. VKDB can be particularly risky for exclusively breastfed infants, as breast milk contains less vitamin K compared to formula milk. Hence, any unexplained bleeding or bruising should be investigated through lab tests.
A severe form of the genetic disorder known as Vitamin K-dependent clotting factors deficiency (VKCFD) exhibits symptoms similar to VKDB, often appearing in the newborn phase. Less severe cases might not show up until later in life. Symptoms typically include a tendency to bleed or bruise easily, bleeding from the mucous membranes, as well as developmental and skeletal abnormalities.
Testing for Vitamin K Deficiency
Vitamin K deficiency in adults is typically identified through an extended prothrombin time (PT), a blood test that measures how fast your blood clots. A slow PT can be remedied by taking in more vitamin K. However, PT isn’t a very precise indicator of vitamin K deficiency because the prothrombin levels in your blood need to be about halved before the PT shows abnormal.
A more sensitive way to check for vitamin K deficiency is by measuring levels of PIVKA-II, also known as Des-gamma-carboxy prothrombin (DCP). These levels stay pretty consistent, not being notably influenced by things like age, which can affect vitamin K levels in the blood and serum. When someone’s taking in less than 60 mcg of vitamin K per day, their PIVKA-II levels start to rise. In newborns, elevated PIVKA-II levels are common. By the time they’re about 4 or 5 days old, about 70% of healthy, non-supplemented infants show increased PIVKA-II levels.
Actually measuring vitamin K levels directly in the blood can give very different results depending on the methodology used, and factors like nutrition or metabolism. It can be even influenced by the lipid content in one’s diet. Although it is beneficial to check the different subtypes and levels of vitamin K in a patient, the preferred method using liquid chromatography–tandem mass spectrometry may not be readily available.
To confirm a diagnosis for Vitamin K deficiency bleeding (or VKDB), the criteria include having a PT that’s at least four times longer than normal, alongside one of the following:
- Either a normal or an elevated platelet count, with normal fibrinogen levels, and no signs of degradation products,
- A return to normal PT measures within half an hour of administering vitamin K intravenously,
- Increased levels of PIVKA-II or DCP.
If Vitamin K-dependent clotting factors deficiency (or VKCFD) is suspected as causing symptoms, genetic testing can be done in a research lab. Specifically, their analysis would examine the gamma-glutamyl carboxylase and the vitamin K 2,3-epoxide reductase complex to get a clear diagnosis.
Treatment Options for Vitamin K Deficiency
To treat vitamin K deficiency in adults, the National Academy of Science Food and Nutrition Board recommends daily vitamin K intake of at least 120 μg for men and 90 μg for women. This can be achieved through diet or via vitamin K supplements. The oral dose for treating vitamin K1 deficiency ranges from 1 to 2 mg, but doesn’t exceed 25 mg. For adults taking blood thinners, the given dose is usually between 1 to 10 mg of vitamin K1. The maximum effect can be seen around 24 hours after the dose.
While there are no official guidelines, recent studies suggest that high doses of vitamins K1 and K2 could have potential benefits for chronic conditions in adults.
To prevent newborns from vitamin K deficiency diseases, doctors typically recommend an intramuscular injection of 0.5 to 1 mg of vitamin K1 within the first hour after birth. Alternatively, an oral dose of vitamin K1 can be given to newborns. The initial dose is 2 mg at birth, followed by additional doses at days 4 to 6 and weeks 4 to 6. Another practice involves an initial oral dose of 2 mg, with weekly doses of 1 mg for three months. However, intramuscular injections are generally preferred for newborns because they work more effectively.
For infants with malabsorption issues resulting in Vitamin K deficiency, the treatment involves daily high-dose oral administration of vitamin K1, which can vary from 0.3 to 15 mg/day, depending on the specific disease. If oral administration is not effective, injections of vitamin K1 may be necessary.
In cases of severe vitamin K deficiency diseases in newborns, 1 to 2 mg of vitamin K1 is typically administered through slow IV or under the skin. In extreme cases, specially prepared blood plasma may be needed.
For individuals with a genetic disorder called vitamin K clotting factor deficiency, the treatment involves oral administration of 10 mg of vitamin K1, usually 2 to 3 times a week. For patients who cannot tolerate oral doses, IV infusion of vitamin K1 is an alternative. In surgical procedures or acute bleeding, plasma might be necessary, generally administered at a dose of 15 to 20 mL/kg. In specific situations, clotting factors may also be administered if needed.
What else can Vitamin K Deficiency be?
Other conditions that involve blood clotting problems can look very similar to a vitamin K deficiency. To know for sure, doctors might see if taking vitamin K supplements helps and they might run specific tests. It’s also important to figure out if the deficiency is due to problems with the body absorbing vitamin K well, or if it’s caused by the person’s diet or the side effects of certain medications like warfarin.
Low levels of vitamin K in adults can lead to other long-term health problems such as weak bones (osteoporosis), heart disease, and other chronic conditions. The signs and symptoms of vitamin K deficiency can also look a lot like those of other health issues, which can make diagnosis a bit complicated.
What to expect with Vitamin K Deficiency
The outlook for people with vitamin K deficiency can depend on several factors including how severe the deficiency is, what’s causing it, and how quickly it’s treated. It’s tricky to assess nutritional deficiencies in adults because other factors can confuse the situation. These factors include the person’s overall nutrition and differences in how their body uses food due to other health conditions or their genes.
If someone has a mild vitamin K deficiency, it’s often possible to fix it by changing their diet or taking supplements. If this works, the person can expect a good outcome with few long-term effects. But if a vitamin K deficiency isn’t treated, it can lead to serious problems. These can include abnormal bleeding, problems with bone development, and even an increased risk of heart disease.
The outlook is linked to how quickly treatment starts, for newborn babies with a vitamin K deficiency. Giving vitamin K at birth greatly reduces the risk of serious bleeding disorders. Late-onset VKDB is really serious and half of the cases have bleeding inside the skull.
In VKCFD, giving vitamin K supplements leads to a generally good outlook with minimal impact on the individual’s life quality.
Knowing about vitamin K deficiency, finding it early, and treating it effectively are crucial to improve one’s health condition and minimize potentially harmful effects for both adults and newborn babies.
Possible Complications When Diagnosed with Vitamin K Deficiency
Lack of vitamin K can cause several problems in your body because it plays a key role in blood clotting, maintaining bone health, and supporting heart function. If you don’t get enough Vitamin K, your body will struggle to produce the necessary elements for clotting blood properly, which can result in a higher risk of bleeding and bruising. The most severe consequence of vitamin K deficiency is hemorrhaging or severe bleeding, which can be particularly dangerous for all ages and even fatal for infants.
Not enough vitamin K also inhibits the process of bone strengthening, leading to poor bone development, higher chances of getting osteoporosis, and an increased risk of bones breaking. There’s also new research that indicates a lack of vitamin K might increase the chances of heart diseases by affecting artery hardening and stiffening. Understanding these complications underlines why it’s important to detect and treat Vitamin K deficiency early enough to prevent these possible negative effects.
Problems That Lack of Vitamin K Can Cause:
- Increased risk of bleeding and bruising
- Severe bleeding, particularly dangerous in infants
- Poor bone development
- Higher chances of getting osteoporosis
- Increased risk of broken bones
- Possibly an increased risk of heart diseases
Preventing Vitamin K Deficiency
It’s crucial that parents are educated about the importance of giving their newborns vitamin K supplements at birth. The goal of this is to prevent a condition known as VKDB, which doesn’t happen often, but could cause serious, life-threatening bleeding. Healthcare professionals can talk with parents about how effective an injection can be at preventing all types of VKDB as opposed to giving it orally. It’s also important to note that the injection only needs to be given once, which means there’s no need for repeat doses of oral vitamin K supplements. Parents who may be worried about a study from 1990 that hinted at a link between giving newborns vitamin K and childhood cancer can rest easy knowing that many further studies have found no such link.
People who have chronic conditions might find vitamin K supplements beneficial too. It’s a good idea for these patients to have a conversation about current research on this topic if they’re interested in pursuing this route.