5 years Post OP - Broken ankle - APTT to high for surgery

Hi need help and advice- sorry it's long! I am 5 years post op RNY - maintaining my weight loss and following vitamin, calcium recommended by Bariatric Assoc. Have blood monitored yearly and because I do not absorb Iron I have has a few infusions. 

I fell Saturday, slipped actually, dr said bones are good just a weird accident and broke 2 bones and dislocated ankle. It was set in soft splint cast by orthopedic and I was scheduled for surgery 9-2. Got a call today my aptt which should be 22 is 43. Meaning I am clotting to slow and primary care will not approve surgery. Have appointment with hematologist 9-2 surgery postponed.

Anyone have anything like this? Any advice?assuming this is vit K deficiency and can't be fixed will I be crippled as my bones will not be pinned and screwed as needed because they are afraid I will bleed out.

Thanks Melissa  

Have you been taking any vitamin K? Is so, what kind and how much? As an RNYer, do malabsorb some fat, so you also malabsorb the fat-soluble vitamins A, D, E, and K, and should be supplementing with 'dry' formulations. If you haven't been taking them, them maybe you can get an infusion of K to raise your levels rapidly. (I don't know that they do this, it's just something you could ask about.)

Thank you for the reply.  I take celebrate multi vitamins and calcium and d3. My dr draws all blood yearly in October.  I have only had a problem with iron and have had some infusions.  Does anyone know if vitamin k can be given as IV? Thank you.

Vitamin K is not generally given via IV, but can be.  Usually that is reserved for when people have INR/PT that is significantly too high and are actually experiencing bleeding issues (and they are also receiving either fresh frozen plasma or blood).  

If there is no actual bleeding issue, it is given by injection because via injection it still acts very quickly (INR/PT usually at a normal level in 24-36 hours) and is safer that way.  Even a very slow infusion of Vit K carries a risk of a severe allergic reaction that can be fatal, so they normally limit it to cases where the risk from existing bleeding and the need to control the bleeding outweighs the significant risk of anaphylaxis.

I once had an INR that literally was higher than the lab at the hospital could measure and had spontaneous bruising all over my body, abdominal pain, and evidence of some internal bleeding, so the ER physician discussed with me the pros and cons of the IV Vit K.  Even with all the bruises (even the palms of my hands were bruised) and evidence of "limited" internal bleeding, they opted for a large Vit K injection along with FFP followed by whole blood and repeated CT scan in a couple of hours.  If my abdominal pain got any worse, though, they would have done the IV Vit K and increased the FFP order until my INR was low enough that they could do surgery to find and fix the bleed.

Lora

Thank you.

I have to take vitamin K.  If I don't, i start bruising very easily.  I don't eat enough greens, and i know i may have issues with absorbing K. 

I take K1 for bruising, and take K2 for bones.  K2 is critical for proper bone formation. Google that. 

Can you tell me what kind and amount of k1 and k2 you take? Thank you.

This isn't anything against Hala (she is a friend), but -- especially since you are having bleeding issues and need surgery –- Your physician really needs to be the one to tell you how much and which kind you should be taking.  When you're dealing with vitamin K and coagulation issues, it's a really bad idea to base your own supplementation on what a random person on the Internet takes.

It isn't really a good idea with any of the vitamins (everything should be based on your individual lab work rather than what other people take), but it can be dangerous with Vitamin K.

Lora