{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T17:42:17Z","timestamp":1787506937367,"version":"build-2736575974"},"reference-count":4,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"abstract":"<jats:p>A man was admitted with abdominal pain. Treatment for acute diverticulitis was instituted with intravenous antibiotics and oral limitation. Imaging demonstrated a complex inflammatory mass. Prothrombin time (PT), activated partial thromboplastin time (APTT) and fibrinogen were within normal limits. However, repeat preoperative clotting studies demonstrated a severe unexpected coagulopathy to have developed since admission that could have caused fatal intraoperative exsanguination. Direct assays showed severe, isolated deficiency of vitamin K dependent clotting factors, and mixing studies normalised both the PT and APTT, ruling out a coagulation inhibitor. The coagulopathy responded to intravenous vitamin K administration. Dietary insufficiency underlies vitamin K deficiency in the presence of normal biliary and enteral function. A significant coagulopathy can result with additional eradication of intestinal microflora. Hypoprothombinaemia is recognised as a consequence of protracted treatment with broad spectrum antibiotics, and vigilance is required for those at risk. The development of such a rapid and unexpected coagulopathy posed a complex preoperative management issue delaying operative intervention; although avoided by fortuitous preoperative screening, it could have caused significant intraoperative bleeding. The remarkably specific lack of vitamin K dependent clotting factors strongly suggested a vitamin K deficiency and administration of coumarins was ruled out.<\/jats:p>","DOI":"10.1136\/bcr.06.2008.0008","type":"journal-article","created":{"date-parts":[[2008,11,21]],"date-time":"2008-11-21T13:17:58Z","timestamp":1227273478000},"page":"bcr0620080008","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Iatrogenic vitamin K deficiency and life threatening coagulopathy"],"prefix":"10.1136","volume":"2008","author":[{"given":"Samuel John","family":"Ford","sequence":"first","affiliation":[{"name":"Cheltenham General Hospital, General Surgery, Sandford Road, Cheltenham, GL537AN, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alistair","family":"Webb","sequence":"additional","affiliation":[{"name":"Cheltenham General Hospital, General Surgery, Sandford Road, Cheltenham, GL537AN, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Payne","sequence":"additional","affiliation":[{"name":"Cheltenham General Hospital, General Surgery, Sandford Road, Cheltenham, GL537AN, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norbert","family":"Blesing","sequence":"additional","affiliation":[{"name":"Cheltenham General Hospital, General Surgery, Sandford Road, Cheltenham, GL537AN, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,8,6]]},"reference":[{"key":"2025082803463583000_2008.aug05_1.bcr0620080008.1","doi-asserted-by":"publisher","DOI":"10.1093\/clinids\/12.6.1109"},{"key":"2025082803463583000_2008.aug05_1.bcr0620080008.2","first-page":"531","article-title":"Reduction of vitamin K2 concentrations in human liver associated with the use of broad spectrum antimicrobials","volume":"17","author":"Conly","year":"1994","journal-title":"Clin Invest Med"},{"key":"2025082803463583000_2008.aug05_1.bcr0620080008.3","doi-asserted-by":"publisher","DOI":"10.1007\/BF01295996"},{"key":"2025082803463583000_2008.aug05_1.bcr0620080008.4","doi-asserted-by":"publisher","DOI":"10.1097\/00001721-200201000-00007"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr.06.2008.0008","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T10:46:43Z","timestamp":1756378003000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr.06.2008.0008"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,6]]},"references-count":4,"alternative-id":["10.1136\/bcr.06.2008.0008"],"URL":"https:\/\/doi.org\/10.1136\/bcr.06.2008.0008","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,6]]}}}