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Klin Padiatr. 1995 May-Jun;207(3):89-97.

Late form of vitamin K deficiency bleeding in Germany.

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1
Universit├Ąts-Kinderklinik Freiburg/Germany.

Abstract

BACKGROUND:

The evaluation of the disease of vitamin K deficiency bleeding (VKDB).

METHOD:

108 reported cases between 1980 and 1990 from Germany.

RESULTS:

VKDB occurs preferentially (90%) in fully breastfed infants, males are affected nearly twice as often as females. The peak age is four weeks; the majority (79%) of the infants are between three and seven weeks old. 58% of the patients suffer from intracranial bleeding, which results in a total mortality rate of 19% and in neurological damage in 21%. Generally the VKDB occurred suddenly as no warning signs were noticed or they were so insignificant as not to be heeded. In at least 37% of the patients cholestasis was detected. The Quick value was pathologically low in every case. Vitamin K dependent factors were low and PIVKA was detectable, whereas vitamin K independent hemostatic parameters were normal or even elevated. The combination of low Quick value and normal fibrinogen as well as platelet level is a good diagnostic indicator which can be confirmed by administration of vitamin K, after which the Quick value will rise within 30 minutes. Vitamin K prophylaxis reduces the incidence of VKDB from 5.13 per 100,000 births to a tenth of that; single dose oral prophylaxis reduces the risk by a factor of 3.3 and a single parenteral dose by 14.3. Parenteral prophylaxis is more effective in patients with hepatobiliary disorders. Patients who suffered VKDB despite having received vitamin K prophylaxis are older at onset (without prophylaxis 32 days, with oral prophylaxis 37 days, and with parenteral prophylaxis 63 days) and have less intracranial bleeding (35%) than patients who received none (62%).

CONCLUSION:

Late form of VKDB is a rare but serious disease which can be prevented by VK-prophylaxis.

PMID:
7623433
DOI:
10.1055/s-2008-1046519
[Indexed for MEDLINE]
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