A 55-Year-Old Man with Chronic Alcohol Abuse Underwent Right-Sided Hemicolectomy

A 55-year-old man with chronic alcohol abuse underwent right-sided hemicolectomy for complicated diverticulitis 10 days ago.  During his hospitalization, he developed abdominal wall hematomas at subcutaneous heparin injection sites.  His preoperative laboratory blood work showed a hemoglobin of 5.4 g/dL, platelets of 87,000/µL, and normal coagulation parameters.  The patient received 8 units of packed red blood cells during the perioperative period.  His hospital course has been complicated by an abdominal wound infection and alcohol withdrawal symptoms.
His temperature is 38.1 C (100.6 F) , blood pressure is 98/56 mm Hg, and pulse is 108/min.  His body mass index is 18 kg/m².  The lungs are clear to auscultation and no murmurs are appreciated.  The incision site is erythematous and tender.  The patient has a palpable spleen tip.  There is no evidence of active mucosal bleeding.  His mental status is normal.
Laboratory results are as follows:

Factor V and VIII levels are normal, and factor VII level is decreased.
Which of the following is the most likely cause of this patient's coagulopathy?

A) Antiphospholipid antibodies
B) Disseminated intravascular coagulation
C) Folic acid deficiency
D) Liver failure
E) Vitamin K deficiency

Correct Answer:

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