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Bleeding due to vitamin K deficiency

May 16, 2012 6:58 am

With cholestasis in infancy, Bill Balistreri taught me that there were four potential emergencies:

• Bleeding due to vitamin K deficiency or coagulopathy
• Hypoglycemia
• Sepsis
• Metabolic poisoning with formula (in patients with galactosemia)

Once these issues have been considered, then it is appropriate to start investigating the etiology of the cholestasis.

One of the more dramatic complications is intracranial hemorrhage (ICH). While ICH is a well-recognized complication of cholestasis in infancy, the long-term outcomes are not well-characterized. A report from Japan adds some insight (JPGN 2012; 54: 552-57).

Among a retrospective review of 83 infants with biliary atresia (BA) between 1979 to 2009, ICH occurred in 8% despite oral vitamin K prophylaxis (2 mg).  The onset of ICH was between 47-76 days after birth and was prior to surgery.  Coagulopathy was noted in all cases, which improved with vitamin K intravenously.  Two infants required craniotomy.  In 5 of 7 cases, neurologic sequelae were noted including developmental delay in three, epilepsy in one, and mild hemiparesis in two.

Additional references:

• Blood Rev 2009; 23: 49-59.  Review of vitamin K deficiency.
• Pediatrics 2008; 121:e857.  Vitamin K deficiency common in cholestatic breastfed babies.  Can be prevented with 1mg po each week or single IM dose of 2mg.
• Eur J Pediatr Surg 2005; 15: 295-9.  Bleeding disorder as 1st symptom of BA.
• Pediatr Neurosurg 2006; 42: 362-7.  ICH due to vitamin K deficiency.
• Pediatrics 2006; 118: e1657.  dose of 0.2mg effective for median of 25days (w/o toxicity/accumulation of K1O) in infants <32weeks gestation.

Posted by gutsandgrowth

Categories: biliary atresia, Pediatric Gastroenterology Liver Disease

Tags: biliary atresia, cholestasis, hypoglycemia, intracranial hemorrhage, vitamin k deficiency

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2 Responses to “Bleeding due to vitamin K deficiency”

1. […] Bleeding due to vitamin K deficiency | gutsandgrowth […]

   By Educated or Misinformed –Leading to Hemorrhagic Disease of the Newborn | gutsandgrowth on December 12, 2013 at 7:10 am

2. […] Bleeding due to vitamin K deficiency | gutsandgrowth […]

   By Clinical Features of Byler Disease | gutsandgrowth on May 17, 2015 at 9:00 am

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