A 56-year-old woman presents with feeling light-headed when standing up and 3 days of passing dark black stools. She has past history of chronic viral hepatitis B, and has developed cirrhosis. On examination she is alert, blood pressure is 90/60 mm Hg supine and 76/60 mm Hg standing. Her abdomen is distended with signs of ascites, nontender, and there are multiple bruises on the legs. Her hemoglobin is 9.0 g/dL,
platelets 90,000/mL, albumin 3 g/dL, bilirubin 1.3 mg/dL, and international normalized ratio (INR) 2.5 (prothrombin time [PT] 25 seconds). Which of the following coagulation factors are most likely deficient in this patient?
(A) V and VIII
(B) VIII, IX, XI, and XII
© XIII
(D) II, V, VII, IX, X, and XI
(E) II, VII, IX, and X
solution:
(D) Coagulation factors II, V, VII, IX, X, and XI would most likely be deficient. These are some of the factors that are synthesized in the liver. Factors II, VII, IX, and X are the vitamin Kdependent factors, which are also synthesized in the liver