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Severe coagulopathy secondary to vitamin K deficiency in patient with small-bowel resection and rectal cancer
Clinical Picture
Severe coagulopathy secondary to vitamin K deficiency in patient with small-bowel resection and rectal cancer Faisal Al-Terkait, Haris Charalambous Lancet Oncol 2006; 7: 188 Northern Centre for Cancer Treatment, Newcastle General Hospital, Westgate Road, Newcastle upon Tyne, NE4 6BE, UK (F Al-Terkait MRCP, H Charalambous FRCR) Correspondence to: Dr Haris Charalambous [email protected]
A 59-year-old-man with Duke’s stage C rectal cancer (pathological stage T3N2) underwent preoperative radiotherapy and resection of the low anterior small bowel with temporary-loop ileostomy. Bolus fluorouracil and folinic acid were given as adjuvant chemotherapy. The concentration of carcinoembryonic antigen before chemotherapy was 108 g/L; however, CT scan of the chest, abdomen, and pelvis showed no evidence of distant metastases. 31 years previously he had undergone extensive subtotal resection of the small bowel after a peptic ulcer perforated. During treatment for Duke’s stage C rectal cancer, he developed increased breathlessness and tiredness. On examination he was pale and had haematomas on both thighs (figure). His haemoglobin concentration was 32 g/L, with abnormal clotting (prothrombin time 100 s and activated partial thromboplastin time 200 s). A coagulation screen showed deficiency of prothrombin, coagulation factors VII, IX, and X, which was consistent with deficiency of vitamin K. Liver-function tests were otherwise normal, and repeated CT of the abdomen showed no evidence of liver metastases. He was given a blood transfusion and intravenous vitamin K, and showed a striking improvement in symptoms and normalisation of clotting. However, 3 months later, liver metastases were found on repeat CT. He was given sequential capecitabine then irinotecan as palliative chemotherapy, but died 1 year later from progressive disease. We suggest that the cause of vitamin K deficiency in this patient was multifactorial, due to the small-bowel resection, temporary loop ileostomy, and subclinical presence of liver metastases. Our experience with this patient reinforces the need for supplementation with vitamin K after resection of the small bowel. Conflict of interest We declare no conflicts of interest.
188
http://oncology.thelancet.com Vol 7 February 2006
Severe coagulopathy secondary to vitamin K deficiency in patient with small-bowel resection and rectal cancer Faisal Al-Terkait, Haris Charalambous Lancet Oncol 2006; 7: 188 Northern Centre for Cancer Treatment, Newcastle General Hospital, Westgate Road, Newcastle upon Tyne, NE4 6BE, UK (F Al-Terkait MRCP, H Charalambous FRCR) Correspondence to: Dr Haris Charalambous [email protected]
A 59-year-old-man with Duke’s stage C rectal cancer (pathological stage T3N2) underwent preoperative radiotherapy and resection of the low anterior small bowel with temporary-loop ileostomy. Bolus fluorouracil and folinic acid were given as adjuvant chemotherapy. The concentration of carcinoembryonic antigen before chemotherapy was 108 g/L; however, CT scan of the chest, abdomen, and pelvis showed no evidence of distant metastases. 31 years previously he had undergone extensive subtotal resection of the small bowel after a peptic ulcer perforated. During treatment for Duke’s stage C rectal cancer, he developed increased breathlessness and tiredness. On examination he was pale and had haematomas on both thighs (figure). His haemoglobin concentration was 32 g/L, with abnormal clotting (prothrombin time 100 s and activated partial thromboplastin time 200 s). A coagulation screen showed deficiency of prothrombin, coagulation factors VII, IX, and X, which was consistent with deficiency of vitamin K. Liver-function tests were otherwise normal, and repeated CT of the abdomen showed no evidence of liver metastases. He was given a blood transfusion and intravenous vitamin K, and showed a striking improvement in symptoms and normalisation of clotting. However, 3 months later, liver metastases were found on repeat CT. He was given sequential capecitabine then irinotecan as palliative chemotherapy, but died 1 year later from progressive disease. We suggest that the cause of vitamin K deficiency in this patient was multifactorial, due to the small-bowel resection, temporary loop ileostomy, and subclinical presence of liver metastases. Our experience with this patient reinforces the need for supplementation with vitamin K after resection of the small bowel. Conflict of interest We declare no conflicts of interest.
188
http://oncology.thelancet.com Vol 7 February 2006