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Factor VII Deficiency from Novel COVID-19 Infection

Alexandra Fincher*, Tyler Badding, Hitesh Agrawal, Robert C Mignacca, Gunjan Dokania

Infection with Coronavirus Disease-19 (COVID-19) can manifest with multi-system sequelae, including thrombosis and other coagulopathies. The effects of COVID-19 on specific coagulation factors are not well known. In this case, proconvertin (Factor VII) deficiency was observed in a 14-year-old pediatric patient with active COVID-19 infection, along with mild thrombocytopenia, active mucosal bleeding, prolonged Prothrombin Time (PT) and likely vitamin K deficiency. Despite worsening thrombocytopenia, the patient's mucosal bleeding subsided with eventual normalization of his coagulation measures following vitamin K supplementation. We postulate that due to widespread inflammation from active COVID-19 infection, our patient developed vitamin K deficiency resulting in acquired Factor VII deficiency. The mechanism of systemic inflammation causing vitamin K deficiency in the setting of COVID-19 infection should be explored in future studies. Furthermore, Factor VII deficiency should be considered in the setting of COVID-19 infection, especially when patients present with excessive bleeding, prolonged PT and normal Activated Partial Thromboplastin Time (APTT).