Fatal Late Vitamin K-Deficiency Bleeding After Oral Vitamin K Prophylaxis Secondary to Unrecognized Bile Duct Paucity

Intestinal absorption of mixed micellar phylloquinone (vitamin K1) is unreliable in infants with conjugated hyperbilirubinaemia: implications for oral prophylaxis of vitamin K deficiency bleeding

“…PIVKA-II circulates at high levels in overt vitamin K deficiency; the mean value in our laboratory in 43 adult patients receiving warfarin treatment (INR > 1.5) was 40.0 AU/ml (range 6.9-99.5 AU/ml), and in an infant with fatal late VKDB it was 67.9 AU/ml. 32 As previously reported, 28 there was good agreement between the specificity of this assay and a commercial kit (Eitest mono-II; Eisai Co Ltd, Tokyo, Japan) which has been widely used in infant studies. 21 33 34 Statistical analysis Statistical analysis between the two groups was carried out using a two tailed Student's t test (for serum K 1 ) and non-parametric tests (for serum PIVKA-II prevalence), as appropriate.…”

Pharmacokinetics and efficacy of oral versus intravenous mixed-micellar phylloquinone (vitamin K1) in severe acute liver disease

“…The minimum limit of detection for our assay was 0.15 AU/ml. In 43 adult patients on warfarin therapy (INR O1.5), the mean value in our laboratory was 40.0 AU/ml (range 6.9-99.5 AU/ml) [16]. As previously reported [17], there was good agreement between the specificity of this assay and a commercial kit (Eitest mono-II; Eisai Co Ltd, Tokyo) which has been used widely for the detection of subclinical vitamin K deficiency [18][19][20].…”

Prevalence of subclinical vitamin K deficiency in Thai newborns: relationship to maternal phylloquinone intakes and delivery risk

“…In healthy, vitamin K-replete adult participants, the concentration of PIVKA-II was <0.15 AU/ml; therefore values above this cut-off were reported as ‘detectable’ and indicative of functional vitamin K insufficiency 18. In overt vitamin K deficiency, PIVKA-II circulates at high levels: values were 6.9–99.5 AU/ml (mean 40.0) in 43 adults on warfarin therapy (International Normalized Ratio ≥1.5)18 and 67.9 AU/ml in an infant with fatal late VKDB 20. PIVKA-II values of ≤1.0 AU/ml are considered insignificant to coagulation16 while values ≥5.0 AU/ml are indicative of overt vitamin K deficiency and clinically relevant.…”