A 78 year old man who lives alone and prepares his own food is found to have ecchymotic patches over posterior aspect of his lower extremities. He has haemorrhagic areas around hair follicles, hair are fragmented and splinter haemorrhages are present in nail beds and several hematomas are present in the muscles of arms and legs. PT and CT are normal. This clinical syndrome is most likely due to :

Ans. is 'b' Vitamin C deficiency Bleeding manifestations with normal prothrombin time and clotting time almost confirms the diagnosis of vitamin C deficiency.Vitamin CVitamin C is required for the synthesis of collagen*It acts as a cofactor in the hydroxylation* of proline* and lysine*Aggregation of polypeptide chain into triple helixSo in Vitamin C deficiency the collagen types with highest hydroxyproline (those in blood vessels) are severely affected. Therefore, the early clinical feature of Vitamin C deficiency is increased tendency to hemorrhage d/t increased fragility of capillaries.Bleeding in Vitamin C is d/t defect in capillary therefore only bleeding time will be increased in Vitamin C deficiency. All other tests such as PT, PTT, Thrombin time, clotting time will remain normalVitamin K deficiencyVitamin K deficient patient can also present with similar bleeding manifestations. In Vitamin K deficiency bleeding occurs d/t lack of coagulation factors (vit K dependent factors which are II, VII, IX, X.)Therefore patients presents with following abnormalitiesClotting time - increasedPTT - increasedPT - increasedThrombin time - increased