Vitamin K Deficiency Bleeding

1
Vitamin K Deficiency Bleeding

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

2
Vitamin K Deficiency

• Incomplete carboxylation of coagulation
• proteins that do not form appropriate complexes
  with Caphospholip

Qualitative deficiency of Factors II,VII,IX,X
BLEEDING
3
Conditions associated with Vit K Bleeding

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

4
VKDB Characteristics
5
Case selection criteria

• Age 2 days to 12 months
• Prolonged PT(gt1.5 times) PTTK
• Which normalised within 24 hrs of Vit K
• Absence of liver disease and/or septicemia

6
Aetiology of Bleeding
7
Clinical presentation
8
Age distribution of VKDB patients
9
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
• gt12 mths.2.5

10
Associated conditions

• Exclusive BF...76
• BF and Top milk feeding.10
• BFDiarrhoeaAntibiotics..14

11
Aetiology of ICH
12
Mortality in VKDB

• Total mortality was 30
• Only in cases
  with ICH

13
Mortality in ICH cases

87.5 .due to VKDB 12.5..due to ITP
14
Why is newborn Vit K deficient?

• Maternalcord blood ratio301
• 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

15
Recommendations to improve Vit K status

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

16
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

17
ALL NEWBORNSHealthy and high-risk

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

18
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

19
IM /oral

• Oral does not prevent late VKDB
• Repeated (monthly)doses

20
Thank you