Treatment of vitamin K—dependent coagulation factor deficiency and subarachnoid hemorrhage.docVIP

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Treatment of vitamin K—dependent coagulation factor deficiency and subarachnoid hemorrhage.doc

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Treatment of vitamin K—dependent coagulation factor deficiency and subarachnoid hemorrhage

Treatment of vitamin K—dependent coagulation factor deficiency and subarachnoid hemorrhage BACKGROUND： In adults， vitamin K-dependent coagulation factor deficiency （VKCFD） increases in the recent years. We treated a VKCFD patient with subarachnoid hemorrhage， with favorable outcomes. METHODS： A 19-year-old male student with VKCFD was treated at our hospital. The initial treatment was injection of a large dose of vitamin K and fresh plasma， and then with oral high dose of vitamin K4. RESULTS： At 4 weeks after admission， the focus of hemorrhage subsided， neurological examination was normal， and the patient was discharged. CONCLUSIONS： VKCFD is rare and its diagnosis should be based on the history of the patient and the results of laboratory examinations. A large dose of vitamin K is the first choice of treatment. KEY WORDS： Vitamin K-dependent coagulation factor deficiency； Subarachnoid hemorrhage； Diagnosis World J Emerg Med 2011；2（1）：73-76 INTRODUCTION With the participation of vitamin K， vitamin K-dependent coagulation factors II， VII， IX and X synthesize in the liver. In the molecular structure of these coagulation factors， there are different numbers of γ carboxyglutamic acid （γ-Gla） residues， which locate in the N-terminal of their own genes.[1] In physiological conditions， these glutamate residues have γ carboxylation reaction catalyzed by the carboxyl enzyme， while vitamin K is essential for the enzymatic reaction. When vitamin K lacks， the γ carboxylation level decreased in the above coagulation factors， which synthesize in the liver without any function. Although these abnormal proteins have antigen function， they are not combined with phospholipid and Ca2+ in the normal way， and can’t play a normal role in blood clotting or anticoagulant activity. This is called vitamin K-dependent coagulation factor deficiency （VKCFD）. In adults， VKCFD has been reported to increase in the recent years. We treated a VKCFD patient with subarachnoid