Choosing Wisely:

Don’t test vitamin K levels unless the patient has an abnormal international normalized ratio and does not respond to vitamin K therapy.

Rationale and Comments: Measurements of the level of vitamin K in the blood are rarely used to determine if a deficiency exists. Vitamin K deficiency is very rare, but when it does occur, a prolonged prothrombin time and elevated international normalized ratio will result. A diagnosis is typically made by observing the prothrombin time correction following administration of vitamin K, plus the presence of clinical risk factors for vitamin K deficiency.
Sponsoring Organizations:
  • American Society for Clinical Pathology
  • Sources:
  • Expert consensus
  • Disciplines:
  • Hematologic
  • References: • Suttie JW. Vitamin K. In: Machlin L, ed. Handbook of Vitamins. New York, NY: Marcel Dekker; 1984:147.
    • Van Winckel M, De Bruyne R, Van De Velde S, Van Biervliet S. Vitamin K, an update for the paediatrician. Eur J Pediatr. 2009;168(2):127-34.
    • Shearer MJ. Vitamin K deficiency bleeding (VKDB) in early infancy. Blood Rev. 2009;23(2):49-59.
    • Van Hasselt PM, de Koning TJ, Kvist N, de Vries E, Lundin CR, Berger R, Kimpen JL, Houwen RH, Jorgensen MH, Verkade HJ; Netherlands Study Group for Biliary Atresia Registry. Prevention of vitamin K deficiency bleeding in breastfed infants: lessons from the Dutch and Danish biliary atresia registries. Pediatrics. 2008;121(4):e857-63.
    • Booth SL, Al Rajabi A. Determinants of vitamin K status in humans. Vitam Horm. 2008;78:1-22.
    • Krasinski SD, Russell RM, Furie BC, Kriger SF, Jacques PF, Furie B. The prevalence of vitamin K deficiency in chronic gastrointestinal disorders. Am J Clin Nutr. 1985;41(3):639-43.
    • Shearer MJ, Fux, Booth SL. Vitamin K nutrition, metabolism, and requirement: current concept and future research. Adv Nutr. 2012;3(2):182-95.
    • Liebman HA, Furie BC, Tong MJ, Blanchard RA, Lo KJ, Lee SD, Coleman MS, Furie B. Des-gamma-carboxy (abnormal) prothrombin as a serum marker of primary hepatocellular carcinoma. N Engl J Med. 1984;310(22):1427-31.

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