A 50-year-old woman with progressive painless obstructive jaundice from a carcinoma of the head of the pancreas has a prothrombin time of 22 seconds (control 12 seconds). She is scheduled for a Whipple procedure in three days. Which is the MOST appropriate preoperative intervention?

• A Fresh frozen plasma transfusion
• B Recombinant activated factor VII
• C Platelet transfusion
• D Parenteral vitamin K administration ✓

Explanation

Cholestasis prevents adequate bile salt delivery to the gut, impairing absorption of fat-soluble vitamin K and reducing synthesis of factors II, VII, IX and X. Parenteral vitamin K corrects the prothrombin time over 12 to 24 hours and addresses the underlying defect. Fresh frozen plasma gives only transient correction lasting hours and is reserved for urgent reversal or active bleeding. Recombinant activated factor VII is costly, thrombogenic and unnecessary here, and platelet count is unaffected by cholestasis.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.