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Vitamin K Deficiency - Causes, Symptoms, Diagnosis, and Treatment

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Vitamin K is essential for blood clotting and wound healing. Read this article to know more about vitamin K.

Written byDr. Lochana. K

Medically reviewed byDr. Mohammad Saquib Alam

Published At March 8, 2022
Reviewed AtSeptember 26, 2024

What Is Vitamin K?

Vitamin K is a component that exists in two primary forms. They are,

  • Vitamin K1 is called phylloquinone.

  • Vitamin K2, called menaquinone.

Vitamin K plays a vital role in the clotting of the blood. Blood clotting is the process required to stop excessive bleeding of the blood. If your body is deficient in vitamin K, your blood will not clot after any accident or injury. Excessive blood loss will invite additional complications. So, vitamin K is closely associated with emergencies. Rather than supplementing vitamin K at the last moment, it is advised to maintain an ideal level of vitamin K all the time for a healthy lifestyle. However, vitamin K deficiency is rare because most foods contain vitamin K.

The daily recommendation of vitamin K is,

  • 120 mcg in males.

  • 90 mcg in females.

What Are the Causes of Vitamin K Deficiency?

The following are the causes of vitamin K deficiency.

  • Taking Medications like Antibiotics: Antibiotics are known to interfere with the blood's clotting mechanism.

  • Fat Malabsorption Syndrome: It is a condition with poor absorption of fat in the body.

  • A diet that is deficient in vitamin K.

  • Anticoagulant drugs like Warfarin. These drugs cause thinning of the blood and will prevent blood clotting.

  • High levels of vitamin A and vitamin E.

  • Cystic Fibrosis: It is a hereditary lung disease that affects the normal lifespan of patients.

  • Celiac Disease: It is an immune disorder in which the small intestine is damaged.

What Are the Symptoms of Vitamin K Deficiency?

The most significant symptom of vitamin K deficiency is bleeding from wounds that would fail to clot.

The other symptoms of vitamin K deficiency are:

  • Formation of tiny blood clots under the nails.

  • A black tarry stool that might be accompanied by blood.

  • Bleeding of the oral mucosa and certain internal organs.

  • The tendency to bruise easily.

What Are the Advantages of Vitamin K?

The following are the advantages of vitamin K:

  • Vitamin K helps build bones and prevent bone loss due to steroids and conditions like osteoporosis. In osteoporosis, the bones become very thin.

  • It helps in maintaining a good texture of hair and healthy strands.

What Are the Rich Sources of Vitamin K?

The foods that are rich in vitamin K are:

  • Cabbage, cauliflower, broccoli, and green leafy vegetables like spinach, lettuce, etc.

  • Sprouts are rich in vitamin K.

  • Fruits like an apple, green apple, avocado, kiwi, grapes, and green pears.

  • Soybeans.

  • Pumpkin.

  • Carrot and pomegranate juice.

  • Meat, fish, liver, and egg.

  • Cereals.

  • Cooked kale.

  • Cucumber and lady's finger.

  • Cheese.

The daily requirement of vitamin K might vary depending upon the age and health condition.

  • Babies less than one year require only 2 - 2.5 mcg per day.

  • Children who are less than three years of age require 13 mcg per day.

  • Children aged around four to eight years require 55 mcg per day.

  • Children belonging to the age group nine to thirteen years require 60 mcg daily.

  • During the teenage years, the requirements of boys and girls will vary. It is around 85 mcg for boys and 75 mcg for girls every day.

  • Pregnant women require a range of 75 mcg to 80 mcg daily.

  • Men who are more than 20 years of age need 120 mcg per day.

  • Women who are more than 20 years of age need 90 mcg per day.

Who Is at Risk of Vitamin K Deficiency?

  • Newborn babies are at increased risk. This is because the mother's breast milk might be low in vitamin K. It is not possible for vitamin K to transfer from the mother's placenta to the fetus fully. It might also be due to the inability of the liver of the baby. In general, the gut of adults is known to produce vitamin K. In babies, the gut is not able to produce vitamins during the initial stages of life.

  • Patients with bleeding disorders like hemophilia, Von Willebrand disease, and disseminated intravascular coagulation.

  • People with sickle cell anemia.

  • Patients with kidney problems.

  • Liver disorders - Patients who have liver problems have an increased tendency to bleed. The bleeding caused due to liver problems becomes hard to treat.

What Is Vitamin K Deficiency Bleeding or VKDB?

Vitamin K deficiency bleeding (VKDB) also known as hemorrhagic disease of the newborn (HDN) is spontaneous bleeding in infants due to inadequate vitamin K. Vitamin K is necessary for blood coagulation as it plays a role in the production of coagulant factors (II, VII, IX and X) in the liver. VKDB is a condition that can be contracted by infants who receive low doses of vitamin K, and the symptoms include bleeding in the skin, the gastrointestinal tract, or even the brain, which could lead to fatal consequences. There are three types of VKDB:

  • Early VKDB: It occurs on the first day of life or within the first 24 hours.

  • The Classical VKDB: One that occurs between one to seven days.

  • Late VKDB: Onset between 2 weeks and 6 months of age

Why Are Babies More Likely to Have Vitamin K Deficiency and Get VKDB?

Newborns are particularly susceptible to vitamin K deficiency for several reasons:

  • Low Vitamin K Stores at Birth: Newborns unlike adults, have low levels of vitamin K, this is because there is limited transfer of vitamin K across the placental membrane from the mother to the fetus.

  • Sterile Gut: Vitamin K is obtained from food but it is produced by bacteria in the intestines and since newborn children are born with germ-free gut, they cannot produce Vitamin K on their own.

  • Breastfeeding: However, breast milk has been shown to have many benefits to the baby but it contains very low amounts of vitamin K as compared to formula milk. This is why exclusively breastfed infants are at a higher risk of developing VKDB should they not receive the prophylactic vitamin K at birth.

What Might Cause Babies to Be Deficient in Vitamin K and Have Bleeding Problems?

Several factors can contribute to vitamin K deficiency in newborns, increasing the risk of VKDB:

  • Lack of Prophylactic Vitamin K at Birth: Newborns are normally administered a vitamin K injection within the first 6–24 hours after birth as a measure against VKDB. In nations where the practice is not common or if the parents do not agree to give their child the injection, the risk of VKDB rises.

  • Maternal Medications: Medications that may affect the metabolism of vitamin K include anticonvulsant agents, anticoagulant agents, and antibiotics, and therefore, may lead to vitamin K deficiency in the newborn where the mother is a user.

  • Preterm Birth: Lungs of premature babies are often less developed than in full-term infants and so is their vitamin K storage, which puts them at a higher risk of bleeding.

  • Cholestasis or Liver Disease: Children with liver disorders or gastrointestinal problems may experience poor absorption or metabolism of vitamin K or a deficiency of this vitamin, which would increase the risk of VKDB.

  • Exclusive Breastfeeding: It is also important to note that breast milk contains very little amount of vitamin K; hence, the child may develop deficiency and bleed if he is not supplemented, especially if he has other conditions like gastrointestinal or liver disease.

How Is Vitamin K Deficiency Diagnosed?

The deficiency of vitamin K requires a few laboratory tests for diagnosis.

The doctor might recommend the following tests:

  • Prothrombin Time Test - The prothrombin time test helps in identifying the time taken by the plasma in the blood to clot. Prothrombin is a component that is involved in the process of blood clotting. Blood is collected from the patients and processed through certain laboratory procedures. Results can be obtained instantly. The normal time taken by the blood plasma to clot is around 11 to 13 seconds. Any delay in these levels might be noted as vitamin K deficiency.

  • Coagulation Test - The coagulation test is useful for the identification of the clotting ability of the blood. This helps in assessing the risk of many severe health conditions.

How Is Vitamin K Deficiency Treated?

Vitamin K deficiency can be treated by dietary supplementation with foods that are rich in vitamin K. Vitamin K can be supplied instantly with the help of injections.

The uses of vitamin K injections are:

  • It will suddenly stop the bleeding at the injured site by increasing the thickness of the blood.

  • Reduced levels of risk of bleeding disorders.

The following are the side effects of vitamin K injection. They are:

  • The injection site might cause swelling, pain, and soreness.

  • Changes in taste.

  • Shortness of breath.

  • Bluish discoloration of the nails, skin, and lips.

  • Excessive sweating.

  • Increased heart rate.

  • Flushing.

  • Dizziness.

  • Allergic reaction.

If these symptoms continue, it is necessary to visit your doctor as soon as possible to prevent further complications.

Conclusion

A deficiency of vitamin K results in various health problems, the main among them being the failure in the blood clotting process. It is rare in adults but can cause prolonged bleeding and easy bruising and can cause life-threatening hemorrhages in newborns. Preventing and managing this deficiency requires knowledge of its causes, which include poor diet, malabsorption issues, or liver problems. Proper diagnosis and management, especially using changes in diet or vitamin K, are important in preventing complications. The practice of giving vitamin K to newborns at regular intervals is still the best way to prevent vitamin K deficiency bleeding (VKDB).

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Frequently Asked Questions

Vitamin K is a fat-soluble vitamin. Vitamin K deficiency is rare in adults as our regular diet contains an adequate amount of these nutrients. Our body also recycles the existing supply of vitamin K. However, certain conditions and some drugs can interfere with vitamin K absorption. It is also common in infants.
Some of the causes of vitamin K deficiency include-
- Taking coumarin anticoagulants such as Warfarin.
- Taking anticoagulants.
- Fat malabsorption.
- Malnutrition and intake of a diet lacking in vitamin K.
The best way to increase vitamin K intake is to eat food sources rich in vitamin K. Vitamin K1 (phylloquinone) is obtained from plants, especially green leafy vegetables and spinach. Vitamin K2 is of bacterial origin and is present in modest amounts in various animal-based and fermented foods. The bacteria naturally produce them in the gut.
Vitamin K deficiency can occur in the first few weeks after birth due to low placental transfer of phylloquinone, low clotting factor levels, and low vitamin K content of breast milk. It is rare in adults and is usually limited to people with malabsorption disorders. People who are at risk for vitamin K deficiency include-
- Newborns cannot use vitamin K efficiently and cannot produce vitamin K efficiently. Therefore, when not treated with vitamin K at birth, such babies have a deficiency.
- People with malabsorption disorders such as cystic fibrosis, celiac disease, ulcerative colitis, etc.
- Vitamin K can also be low in patients who have undergone bariatric surgery.
- Antibiotics can reduce the vitamin K-producing bacteria in the gut and eventually decrease vitamin K status.
- Certain medications like Warfarin, bile acid sequestrants (drugs used to reduce cholesterol level), Orlistat (weight loss drug).
Vitamin K is found in vegetables, especially green leafy vegetables, vegetable oils, and some fruits. They include kale, mustard greens, Brussels sprouts, prunes, kiwi, avocado, spinach, parsley (fresh), cabbage, broccoli, beans, peas, lentils, iceberg lettuce, soybean, nuts, blackberries, blueberries, pomegranate, figs, pumpkin, tomatoes, grapes, red currants, and canola oil.
Vitamin K toxicity is extremely rare, and no toxic dose is noted in the literature. But patients should not take excessive amounts of vitamin K. It can cause jaundice in newborns, hemolytic anemia, and hyperbilirubinemia. In addition, it can block the effect of oral anticoagulants.
Eggs contain a fairly good source of vitamin K, and their vitamin content depends on the animal’s diet, and values vary depending on the region and the producer.
Vitamin K deficiency can be treated using supplements and injections. Dark leafy vegetables are a natural source of vitamin K, and they are advised to be included in the diet. In newborns, a vitamin K shot is administered at birth and especially when the baby has the following conditions, which include-
- Premature delivery.
- Maternal use of antiseizure drugs, anticoagulants, or drugs for tuberculosis.
- Babies who have fat malabsorption.
Vitamin K is a group of vitamins the body needs for blood clotting, and it also helps in wound healing. In addition, vitamin K is responsible for preventing bleeding and bone formation. Beyond blood and bone hemostasis, they are involved in various processes such as inflammation, testosterone production, cancer progression, neuroprotective effect, bile acid metabolism, insulin secretion, and type 2 diabetes.
Vitamin K is a fat-soluble vitamin, and it is stored in the fat tissue and liver. They participate in the synthesis of several proteins that mediate coagulation. In addition, the liver synthesizes bile acids, and it plays a critical role in lipid absorption. Therefore, vitamin K requires proper lipid absorption for its own absorption. Liver disease that causes decreased bile salt synthesis leads to impaired vitamin K absorption and deficiency.
Increased intake of vitamin K can decrease the effectiveness of Warfarin and result in the formation of blood clots, which can increase the risk of heart attacks, strokes, and pulmonary embolism. It is also seen that high levels of dietary intake or genetic predisposition might increase the risk of cardiovascular disease. But sufficient vitamin K intake in the diet may protect against atherosclerotic cardiovascular disease events.
Many drugs can interfere with the effects of vitamin K like antacids, blood thinners, antibiotics like cephalosporins, Aspirin, and drugs used for cancer, seizure, high cholesterol, and other conditions. Therefore, it is advised to consult your physician before taking any supplements or medicines.
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Dr. Mohammad Saquib Alam from iCliniq
Dr. Mohammad Saquib Alam

General Practitioner

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