Abstract
This study examined the prevalence of vitamin K deficiency in children pre-bone marrow transplantation (BMT). Vitamin K status was measured by the PIVKA-II assay and prothrombin times. Blood samples were obtained before vitamin-containing TPN was infused. Results indicated that eight of 26 patients (31%) were vitamin K deficient; four cases were attributed to drug antagonism (phenytoin) and four were due to inadequate vitamin K intake, synthesis or malabsorption. Only one patient had a prolonged prothrombin time. Prothrombin time, in our study, is shown to be an ineffective screening tool to determine vitamin K status. All patients receiving phenytoin and chemotherapy are at increased risk of vitamin K deficiency.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Rent or buy this article
Prices vary by article type
from$1.95
to$39.95
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Carlin A, Walker WA . Rapid development of vitamin K deficiency in an adolescent boy receiving total parenteral nutrition following bone marrow transplantation. Nutr Rev 1991; 49: 179–183.
Shearer MJ, Williams A, Sen V, Schey SA . Vitamin K status of patients undergoing autologous bone marrow transplantation. Thromb Haemost 1991; 65: 1220 (abstract).
Carlin A, Davidson K, Sadowski J, O’Brien RS, Weinstein H, Lo C . Vitamin K levels and epoxide/vitamin K ratios in pediatric BMT patients receiving TPN. J Parenter Enteral Nutr 1992; 84 (abstract).
Elston TN, Dudley JM, Shearer MJ, Schey SA . Vitamin K prophylaxis in high-dose chemotherapy. Lancet 1995; 345: 1245.
Fainstein V, Bodley GP, McCredie KB, Keating MJ, Estey EH, Bolivar R et al. Coagulation abnormalities induced by β-lactam antibiotics in cancer patients. J Infect Dis 1983; 148: 745–750.
Conly J, Suttie J, Reid E, Loftson J, Ramotar K, Louie T . Dietary deficiency of phylloquinone and reduced serum levels in febrile neutropenic cancer patients. Am J Clin Nutr 1989; 50: 109–113.
Jones PG, Strother SV, Rolston KV, Fainstein V, Bodey GP . Hypoprothrombinemia in patients with cancer receiving cefoperazone and mezlocillin. Arch Intern Med 1986; 146: 1397–1399.
Motohara K, Kuroki Y, Kan H, Endo F, Matsuda I . Detection of vitamin K deficiency by use of an enzyme-linked immunosorbent assay for circulating abnormal prothrombin. Pediatr Res 1985; 19: 354–357.
Quick AJ . Hemorrhagic Diseases and Thrombosis, 2nd edn. Lea & Febiger: Philadelphia, 1966.
Andreasen PB, Lyngbye J, Trolle E . Abnormalities in liver function tests during long-term diphenylhydantoin therapy in epileptic out-patients. Acta Med Scand 1973; 194: 261–264.
Mountain KR, Hirsh J, Gallus AS . Neonatal coagulation defect due to anticonvulsant drug treatment in pregnancy. Lancet 1970; 1: 265–268.
Davies VA, Rothberg AD, Argent AC, Atkinson PM, Staub H, Pienaar NL . Precursor prothrombin status in patients receiving anticonvulsant drugs. Lancet 1985; 1: 126–128.
Tam DA, Myer EC . Vitamin K-dependent coagulopathy in a child receiving anticonvulsant therapy. J Child Neurol 1996; 11: 244–246.
Rickard KA, Grosfeld JL, Coates TD, Weetman R, Baehner RL . Advances in nutrition care of children with neoplastic disease: a review of treatment, research, and application. J Am Diet Assoc 1986; 86: 1666–1676.
Kaufman PA, Jones RB, Greenberg CS, Peters WP . Autologous bone marrow transplantation and factor XII, factor VII, and protein C deficiencies. Cancer 1990; 66: 515–521.
Scrobohaci ML, Drouet L, Monem-Mansi A, Devergie A, Baudin B, D’Agay MF et al. Liver veno-occlusive disease after bone marrow transplantation, changes in coagulation parameters and endothelial markers. Thromb Res 1991; 63: 509–519.
Pihusch R, Salat C, Schmidt E, Gohring P, Pihusch M, Hiller E et al. Hemostatic complications in bone marrow transplantation: a retrospective analysis of 447 patients. Transplantation 2002; 74: 1303–1309.
Schneider DT, Cho J, Laws HJ, Dilloo D, Gobel U, Nurnberger W . Serial evaluation of the oncological pediatric risk of mortality (O-PRISM) score following allogeneic bone marrow transplantation in children. Bone Marrow Transplant 2002; 29: 383–389.
Acknowledgements
We acknowledge the ongoing support of Dr Fred Saunders, Dr Melvin Freedman and the nurses at the BMT unit. This study was generously supported by a grant from the Canadian Foundation for Dietetic Research.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Barron, M., Doyle, J. & Zlotkin, S. Vitamin K deficiency in children pre-bone marrow transplantation. Bone Marrow Transplant 37, 151–154 (2006). https://doi.org/10.1038/sj.bmt.1705215
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.bmt.1705215