Vitamin K Deficiency Bleeding

Dr. Meenakshi Sharma Professor in Pediatric Medicine SMS Medical College & SPMCHI, Jaipur

Vitamin K Deficiency
Incomplete carboxylation of coagulation proteins that do not form appropriate complexes with Ca&phospholip

Qualitative deficiency of Factors II,VII,IX,X

BLEEDING

Conditions associated with Vit K Bleeding

Hemorrhagic deficiency of newborn & infants(VKDB) Chronic diarrhoeas & malabsorption Liver disorders-hepatitis Warfarin and other drugs Prolonged antibiotics

VKDB Characteristics
Type Onset Details
h/o drug intake in mother Anticonv;antiTB,coumarins, salicylates , Poor nutrition:: Scalp,GI,ICH
Usually in breast fed babies::GI,Skin,nasal Common in breast fed rare in top fed and vit K rcd at birth..50%ICH,GI

Early

Within 24 hrs
2-7 days

Classical

Late

1-6 months

Case selection criteria

1. 2.

3.
4.

Age 2 days to 12 months Prolonged PT(>1.5 times) & PTTK Which normalised within 24 hrs of Vit K Absence of liver disease and/or septicemia

Aetiology of Bleeding
Aetiology VKDB Hemophilia ITP DIC Chronic liver diseases Afibrinogenemia OthersALL,MDS Percentage 40 15 13 12 04 01 15

Clinical presentation
Presentation
Skin GI Bleed Epistaxis Hemarthrosis ICH

VKDB
60%

Hemo

ITP

DIC

47.5%

6.6%

15.2%

Age distribution of VKDB patients

Age 0-1 day 1-3 days 3-6 days 6-30 days 1-3 mths 3-6 mths 6-9 mths 9-12 mths >12 mths Percentage 7.5 5.0 27.5 32.5 7.5 10.5 7.5 2.5

Age distribution in VKDB

0-1 days..nil 1-6 days..12.5% 7-30 days27.5% 1-3 mths..32.5% 3-6 mths..07.5% 6-9 mths..10% 9-12 mths7.5% >12 mths.2.5%

Associated conditions
Exclusive BF...76% BF and Top milk feeding.10% BF+Diarrhoea+Antibiotics..14%

Aetiology of ICH
VKD ITP Hemophilia

Mortality in VKDB
Total mortality was 30% Only in cases with ICH

Mortality in ICH cases

87.5% .due to VKDB 12.5%..due to ITP

Why is newborn Vit K deficient?

Maternal:cord blood ratio30:1 Hepatic content in neonate-25% of adult Human milk content(2-15ug/l)-25% cowmilk Colostrum rich in Vit K not given Sterile gut Plasma half-life-72 hrs Liver storage one month

Recommendations to improve Vit K status

Admn of Vit K to 1. All pregnant mothers 2. ALL NEWBORNS( healthy or high risk) s 3. All infants with diarrhoea or antibiotics 4. Routinely to all infants once a month

Pregnant mothers

Tablets of vit k 20mg/day in the last month of pregnancy--Improve blood levels of newborn Improve Vit K content of breast milk Esp. in mothers taking medications Must be given routinely

ALL NEWBORNS Healthy and high-risk

Vit K 0.5mg 1mg IM 1-4 mg PO Born at homePO At the first contact IM /PO

Other infants
With diarrhoea of more than 1 week Antibiotics of more than one week All other infants presenting with bleeding Dose---1-2mg IM 2-4mg PO

IM /oral
Oral does not prevent late VKDB Repeated (monthly)doses