Daer Graham,
We recieve a lot of requests from Junior doctors for "Vitamins A, D, E and
K". When questioned, the requester usually explains that they're trying to
monitor fat-soluble vitamin levels, and covering all bases.
Here in Manchester, we measure Vits A and E, we do a bone profile (as a
surrogate marker for Vit K) but we will only check Vitamin D and
prothrombin time as second line tests if indicated.
There is published evidence that CF patients are at no greater risk of
vitamin D deficiency than the population at large, and though there is
some evidence that CF patients with pancreatic insufficiency and liver
disease may be at slightly increased risk of Vitamin K deficiency, the
functional significance of mild or moderate reductions in mass
concentration of K has been questioned, not least because we're not over-
run with CF patients with bleeding disorders and prolonged PT!
I think once upon a time the Haematology dept at Chelsea measure
phylloquinine levels, but not certain they still do.
Overall, I don't think the evidence supports measuring Vitamin K as part
of the CF annual review in all patients.
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