A 50-year-old man with cirrhosis has PT 24 seconds, aPTT 48 seconds, and platelets 70,000 per microliter. To decide whether vitamin K deficiency contributes, which single factor level best separates advanced hepatocellular disease from isolated vitamin K deficiency?

• A Factor V level ✓
• B Factor VII level
• C Fibrinogen level
• D Protein C level

Explanation

Factors II, VII, IX, and X are vitamin K dependent, but factor V is synthesized by the liver without any vitamin K requirement. In pure vitamin K deficiency, factor V remains normal while the vitamin K dependent factors fall. In advanced hepatocellular failure, all liver-synthesized coagulation factors including factor V decline. B low factor V therefore points to synthetic liver failure rather than vitamin K deficiency, and it also forms part of prognostic scoring in fulminant hepatic failure.

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

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