A study of the prevalence of vitamin K deficiency in patients with cancer referred to a hospital palliative care team and its association with abnormal haemostasis

Abstract

Aim: Many patients with advanced cancer are malnourished. Anorexia is common, as is the use of chemotherapy, which may cause nausea and poor appetite. 10% of these patients experience haemorrhagic events. Since vitamin K deficiency (VKD) causes bleeding, we established the prevalence of VKD in patients with advanced cancer receiving palliative care. Methods: We determined the serum concentration of vitamin K1 and undercarboxylated factor II (PIVKA-II) in 46 (17 male/29 female) inpatients aged (mean) 26-85 (58) years. INR and liver function tests (bilirubin, ALT, GGT and ALP) were also performed. Results: Vitamin K1 was below the lower limit of the reference range (0.33 nmol/L) in 22% of patients. 78% of patients had some degree of functional VKD indicated by raised ( > 0.2 AU/mL) PIVKA-II. Six patients (13%) had a prolonged INR, all of whom had raised PIVKA-II and GGT levels, and 4 also had a vitamin K1 concentration < 0.33 nmol/L. Three patients (6.5%) had clinically significant VKD characterized by an INR > 1.5, a PIVKA-II > 10 AU/mL, and undetectable vitamin K1. Conclusions: Patients with advanced cancer are prone to VKD which while usually subclinical may develop to a clinically relevant prolongation of the INR. Serum measurements of vitamin K1 and PIVKA-II can be used to detect VKD and monitor vitamin K status before an increased risk of bleeding develops.