Late form of vitamin K deficiency bleeding in Germany

Klin Padiatr. May-Jun 1995;207(3):89-97. doi: 10.1055/s-2008-1046519.

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.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Blood Coagulation Tests
  • Brain Damage, Chronic / blood
  • Brain Damage, Chronic / mortality
  • Brain Damage, Chronic / prevention & control
  • Breast Feeding
  • Cerebral Hemorrhage / blood
  • Cerebral Hemorrhage / mortality
  • Cerebral Hemorrhage / prevention & control
  • Cross-Sectional Studies
  • Female
  • Germany / epidemiology
  • Humans
  • Incidence
  • Infant
  • Infant, Newborn
  • Male
  • Nutritional Requirements
  • Vitamin K / administration & dosage
  • Vitamin K / blood
  • Vitamin K Deficiency / blood*
  • Vitamin K Deficiency / mortality
  • Vitamin K Deficiency / prevention & control
  • Vitamin K Deficiency Bleeding / blood*
  • Vitamin K Deficiency Bleeding / mortality
  • Vitamin K Deficiency Bleeding / prevention & control

Substances

  • Vitamin K