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Heme: Rheum:
- Vitamin K deficiency bleeding - ITP/autoimmune disease
- Thrombocytopenia - vasculitis
- platelet dysfunction
- coagulation factor deficiency
Other:
- NAT
Suspected vitamin K deficiency bleeding
PLAUSIBLE HISTORY + EVIDENCE OF COAGULOPATHY = PRESUMPTIVE
TREATMENT WITH IV VITAMIN K
Suspected vitamin K deficiency bleeding
PLAUSIBLE HISTORY + EVIDENCE OF COAGULOPATHY = PRESUMPTIVE
TREATMENT WITH IV VITAMIN K
LATE ONSET VKDB CARRIES A 22% MORTALITY RATE AND 25-67% RATE
OF ADVERSE NEURODEVELOPMENTAL OUTCOMES
What Next?
What Next?
Transfer to PCH, direct admission to IMSU
Labs? Imaging?
Labs? Imaging?
CBC: WBC 12.6, Hgb: 11.2, Hct 31.7, Plt 397
CMP: Na 136, K 4.6, Cl 107, CO2 20, BUN 10, Cr 0.24, Glu 126, Tbili 3.8,
Dbili 2, AP 416, AST 42, ALT 19, GGT 51
Head CT:
GIVE VITAMIN K
Next steps?
Give vitamin K → 5 hours later: PT 13.4, PTT 33, INR 1.0
Next steps?
Give vitamin K → 5 hours later: PT 13.4, PTT 33, INR 1.0
Pre-prophylactic vitamin K:
Late VKDB: 25/100,000 (80 in low/middle income
countries, 8.8 in high income countries)
Late or classical VKDB: 327/100,000
Post-prophylactic vitamin K:
98% reduction - 6/100k in LMIC, 0.76/100k in HIC
NNT 1275, but cost-effective
Risk factors for VKDB despite vitamin K at birth include
exclusive breast feeding, diarrhea, antibiotic use
Vitamin K Deficiency Bleeding
Pathogenesis
Immature liver utilizes vitamin K inefficiently
Low vitamin K stores
Low vitamin K content in BM
Sterile gut
Poor placental transfer of vitamin K
Vitamin K
Deficiency
Bleeding
Pathogenesis
FACTORS II, VII, IX, AND X ARE
VITAMIN K DEPENDENT
Vitamin K Deficiency Bleeding
Prevention/Treatment
Prevention: 0.5-1 mg vitamin K IM at delivery
Alternative: 2 mg vitamin K PO at 1, 4, and 8 weeks – not as effective
Treatment: 1-2 mg vitamin K IV
Expect resolution of coagulopathy in 2-3 hours
Can add FFP for severe bleeding
Case Outcome
Over the next several hours, worsening mental status PICU for urgent EVD placement
Developed clinical seizures, started on phenobarb Keppra
Up to Date