A 56-year-old woman presents with feeling light-headed when standing up and 3 days of passing dark black stools. She has a past history of chronic viral hepatitis B, and has developed cirrhosis.On examination, she is alert, blood pressure is 90/60 mm Hg supine and 76/60 mm Hg standing. Her abdomen is distended with signs of ascites, it is nontender, and there are multiple bruises on the legs. Her hemoglobin is 9.0 g/dL, platelets 90,000/mL, albumin 3 g/dL, bilirubin 1.3 mg/dL, and international normalized ratio (INR) 2.5 (prothrombin time 25 seconds). Which of the following coagulation factors are most likely deficient in this patient?

**Core Concept**
The patient's presentation suggests a coagulopathy, likely related to her cirrhosis. **Liver disease** can lead to coagulation factor deficiencies due to impaired liver function. The liver produces most of the coagulation factors, including those dependent on **vitamin K**.

**Why the Correct Answer is Right**
The patient's elevated INR and prolonged prothrombin time suggest a deficiency in coagulation factors, particularly those that are vitamin K-dependent. **Factors II, VII, IX, and X** are vitamin K-dependent and are often deficient in patients with liver disease. Given the patient's cirrhosis and coagulopathy, it is likely that she has a deficiency in one or more of these factors.

**Why Each Wrong Option is Incorrect**
**Option A:** This option is not provided, so we cannot assess its correctness.
**Option B:** This option is not provided, so we cannot assess its correctness.
**Option C:** This option is not provided, so we cannot assess its correctness.
**Option D:** This option is not provided, so we cannot assess its correctness.

**Clinical Pearl / High-Yield Fact**
Patients with cirrhosis are at risk of developing coagulopathy due to impaired liver function. **Vitamin K-dependent factors** are often deficient in these patients, leading to an increased risk of bleeding.

**Correct Answer:** D. Factors II, VII, IX, X

✓ Correct Answer: D. II, V, VII, IX, X, and XI