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Factor II deficiency

Definition

Factor II deficiency is a blood clotting (coagulation) problem that occurs when there is a lack of a substance (prothrombin) that is needed for blood to clot.

Alternative Names

Hypoprothrombinemia; Prothrombin deficiency

Causes, incidence, and risk factors

When you bleed, the body launches a series of reactions that help the blood clot. This is called the coagulation cascade. The process involves special proteins called coagulation or clotting factors. When one or more of these clotting factors are missing, there is usually a higher chance of bleeding.

This disorder occurs when the body does not have enough factor II, an important blood clotting protein. Factor II deficiency that runs in families (inherited) is very rare. Both parents must be carriers to pass it to their children. A family history of a bleeding disorder is a potential risk factor.

Most commonly, factor II deficiency is caused by:

• Lack of vitamin K due to long-term use of antibiotics, bile duct obstruction, or poor absorption of vitamin K from the intestines. Some babies are born with vitamin K deficiency.
• Severe liver disease
• Use of drugs that prevent clotting (anticoagulants such as warfarin or Coumadin)

Symptoms

• Abnormal bleeding after delivery
• Abnormal menstrual bleeding
• Bleeding after surgery
• Bleeding after trauma
• Bruising
• Nosebleeds (epistaxis)
• Umbilical cord bleeding at birth

Signs and tests

• Factor II assay
• Partial thromboplastin time
• Prothrombin time (PT)

Treatment

You can control blood loss by getting infusions of fresh or frozen plasma or concentrates of clotting factors into the blood. If a lack of vitamin K is causing the disorder, you can take vitamin K by mouth, through injections under the skin, or through a vein (intravenously).

Diagnosing a bleeding disorder is important so that the doctor can take extra care if you need surgery, and can test or warn other family members who might be affected.

Support Groups

You can ease the stress of illness by joining a support group where members share common experiences and problems. See hemophilia - resources.

Expectations (prognosis)

The outcome can be good with proper treatment.

This is a life-long bleeding disorder if you get it from your parents.

If it is caused by liver disease, the outcome depends on how well your liver problem can be treated. Taking vitamin K will treat vitamin K deficiency.

Complications

Severe bleeding, even into the brain, can occur.

Calling your health care provider

Go to the emergency room or call the local emergency number (such as 911) if you have unexplained or long-term blood loss or if you can't control the bleeding.

Prevention

Genetic counseling may be helpful for disorders that start at birth (congenital). When a lack of vitamin K is the cause, using vitamin K can help.

References

Gailani D, Neff AT. Rare coagulation factor deficiencies. In: Hoffman R, Benz EJ Jr., Shattil SJ, et al, eds. Hoffman Hematology: Basic Principles and Practice. 5th ed. Philadelphia, Pa: Churchill Livingstone Elsevier;2008:chap 127.

Kessler C. Hemorrhagic disorders: Coagulation factor deficiencies. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 180.