Clotting factors reduced production

Recessively inherited coagulation disorders (RICDs) refer to relatively rare deficiencies in factor II, V, VII, and X-XIII resulting in either decreased clotting factor production or production of a dysfunctional molecule with reduced activity.19 The clinical severity of bleeding varies and generally is poorly correlated with the factor blood levels. Table 64-6 illustrates these clotting factor deficiencies and some of their characteristics. 

Warfarin is an oral anticoagulant which interferes with the actions ofvitamin K to reduce production of blood-clotting factors. Dosage of warfarin is critical and patients clotting times are monitored to allow adjustment of dosage to their particular requirements. 

Patients with severe liver dysfunction are more prone to bruising and bleeding as a result of reduced clotting factor production or vitamin K deficiency. The severity increases with worsening liver function. Bruising and bleeding can also be caused by other coagulation disorders. 

Increased sensitivity to drugs is also encountered in liver disease. The use of anticoagulants increases the risk of bleeding due to the reduced absorption of vitamin K or decreased production of vitamin K-dependent clotting factors. There is an enhanced risk for respiratory depression and hepatic encephalopathy due to morphine or barbiturates in patients with severe liver disease. Vigorous use of diuretics can precipitate hepatic coma due to potassium loss in liver disease. There is an increased risk of hypoglycemia with... 

Many androgens and anabolic steroids reduce the dose of oral anticoagulant that a patient requires, sometimes by as much as 25% (73), and hemorrhage has sometimes resulted from their use. From the results of a study in which stanozolol reduced warfarin requirements, the investigators concluded that stanozolol increased fibrinolysis, reduced the production of vitamin K-dependent clotting factors, and increased the amount of the natural anticoagulant antithrombin III (74). 

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