" Coagulation mechanisms in twelve cases of severe kwashiorkor and eight cases of severe marasmus showed differences between the two syndromes. In the marasmus group coagulation mechanisms were normal except in two cases complicated by severe diarrhoea with dehydration who showed a drop in the vitamin K dependent factors." On the other hand cases of kwashiorkor showed marked and constant disturbances involving factors II, VII and X. Parenteral administration of vitamin K raised factor VII significantly in five cases of kwashiorkor while factors II and X were not changed. The latter two factors returned to normal about one week after introduction of a high-protein diet with vitamin K supplements which produced an appreciable rise in serum proteins. In three fatal cases of kwashiorkor with a secondary infection a further drop in the subnormal coagulation factors was found together with a drop in serum proteins. In their terminal state factor V dropped to subnormal level. A marked drop in factor V was also found in two additional cases of kwashiorkor: one associated with hepatic dysfunction and the other with thrombocytopenic purpura and haemorrhage. It is suggested that protein deficiency and hypo-vitaminosis K contribute to the pathogenesis of coagulation factor disturbances in kwashiorkor.".