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Vitamin K Deficiency Bleeding

Dr. Meenakshi Sharma

Professor in Pediatric Medicine

SMS Medical College & SPMCHI,

Jaipur

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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

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Conditions associated with Vit

K Bleeding Hemorrhagic deficiency of newborn &

infants(VKDB)

Chronic diarrhoeas & malabsorption

Liver disorders-hepatitis

Warfarin and other drugs Prolonged antibiotics

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Type Onset Details

Early Within

24 hrs

h/o drug intake in mother

Anticonv;antiTB,coumarins,

salicylates , Poor nutrition::

Scalp,GI,ICH

Classical

2-7

days Usually in breast fedbabies::GI,Skin,nasal

Late

1-6

months

Common in breast fed -

rare in top fed and vit K rcd at

birth..50%ICH,GI

VKDB Characteristics

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Case selection criteria

1. Age 2 days to 12 months

2. Prolonged PT(>1.5 times) & PTTK

3. Which normalised within 24 hrs of Vit K

4. Absence of liver disease and/or septicemia

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Aetiology of Bleeding

Aetiology Percentage

VKDB

Hemophilia

ITP

DIC

Chronic liver diseasesAfibrinogenemia

OthersALL,MDS

40

15

13

12

0401

15

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Clinical presentation

Presentation VKDB Hemo ITP DIC

Skin

GI Bleed

Epistaxis

Hemarthrosis

ICH

60%

47.5% 6.6% 15.2%

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Age distribution of VKDB patients

Age Percentage0-1 day -

1-3 days 7.5

3-6 days 5.06-30 days 27.5

1-3 mths 32.5

3-6 mths 7.56-9 mths 10.5

9-12 mths 7.5

>12 mths 2.5

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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%

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Associated conditions

Exclusive BF...76%

BF and Top milk feeding.10%

BF+Diarrhoea+Antibiotics..14%

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Aetiology of ICHVKD

ITP

Hemophilia

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Mortality in VKDB

Total mortality was 30%

Only in cases with ICH

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Mortality in ICH cases

87.5% .due to VKDB12.5%..due to ITP

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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 storageone month

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Recommendations to improve

Vit K statusAdmn 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

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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

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ALL NEWBORNS

Healthy and high-risk

Vit K 0.5mg1mg IM

1-4 mg PO

Born at homePO

At the first contact IM /PO

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Other infants

With diarrhoea of more than 1 week

Antibiotics of more than one week

All other infants presenting with bleedingDose---1-2mg IM

2-4mg PO

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IM /oral

Oral does not prevent late VKDB

Repeated (monthly)doses

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