The patient has cystic fibrosis which can result in vitamin K deficiency and a prolonged PT.
Cystic fibrosis results from an autosomal recessive mutation in the gene for CFTR, an ion channel that actively secretes Cl- in the lungs and GI tract. Patients have recurrent pulmonary infections, chronic bronchitis, bronchiectasis, pancreatic insufficiency, nasal polyps, and infertility (~97% males and variable in females). As a result of the pancreatic insufficiency, patients may have deficiencies in the fat soluble vitamins (A, D, E, and K). Vitamin K deficiency leads to deficiencies of coagulation factors II, VII, IX, X, and proteins C and S. As a result of vitamin K deficiency, patients may have a prolonged PT.
Hamer and Parker discuss treatment of cystic fibrosis in adults. Respiratory decompensation is usually the result of infective agents, including Pseudomonas aeruginosa, Stentrophomonas maltophilia and Burkholderia cepacia, and requires treatment with intravenous antibiotics. If symptoms worsen, the possibility of another complication, such as pneumothorax, hemoptysis, mycobacterial infection and allergic bronchopulmonary aspergillosis, must be considered.
Jagannath et al. discuss vitamin K supplementation for cystic fibrosis. Malabsorption of fat and fat-soluble vitamins (A, D, E, K) may occur and can cause subclinical deficiencies of some of these vitamins. Vitamin K is known to play an important role in both blood coagulation and bone formation. Supplementation with vitamin K appears to be one way of addressing the deficiency, but there is very limited agreement on the appropriate dose and frequency of use of these supplements. Evidence from randomized controlled trials on the benefits of routine vitamin K supplementation for people with CF is currently weak and limited to two small trials of short duration. However, no harm was found.
Illustration A depicts the clotting cascade.
Illustration B depicts the organ systems affected in cystic fibrosis.
Answer 1: Vitamin C deficiency causes scurvy due to failure of collagen processing. This manifests as connective tissue defects such as poor wound healing.
Answer 2: Vitamin B2 deficiency may result in corneal vascularization.
Answer 3: Wernicke-Korsakoff Syndrome (triad of confusion, ophthalmoplegia, and ataxia) is caused by deficiency in vitamin B1.
Answer 4: Biotin deficiency may be caused by excessive ingestion of raw eggs.
Hamer L1, Parker HW.Treatment of cystic fibrosis in adults. Am Fam Physician. 1996 Sep 15;54(4):1291-7.
PMID:8816573 (Link to Abstract)
Jagannath VA1, Fedorowicz Z, Thaker V, Chang AB.Vitamin K supplementation for cystic fibrosis.Cochrane Database Syst Rev. 2013 Apr 30;4:CD008482. doi: 10.1002/14651858.CD008482.pub3.
PMID:23633357 (Link to Abstract)