Abstract Ref Number = APCP1019
LATE VITAMIN K DEFICIENCY BLEEDING IN INFANTS PREVIOUSLY RECEIVING VITAMIN K INJECTION AFTER BIRTH - A REPORT OF TWO CASES
Kharisma Hapsara,Ratna Kartini
Emergency Department dr R Koesma General Hospital Tuban Indonesia Department of Child Health, dr R Koesma General Hospital, Tuban, Indonesia
Background : Late vitamin K deficiency bleeding (VKDB) is a syndrome defined as unexpected bleeding attributable to severe vitamin K deficiency in infants aged 2 to 12 weeks. It's rarer than the early and classical VKDB, occurring in 1 in 14.000 - 25.000 infants.
Case Presentation Summary : Two cases of late VKDB were reported. Both infants were male, aged 9 weeks and 5 weeks. The two infants came to the ER with decreased consciousness, recurrent seizures, and frequent vomiting. They all had been healthy, exclusively breastfed, and developing normally, with no family history of excessive bleeding. They also had received intramuscular vitamin K injection after birth. Physical examination showed pallor, bulging fontanelle, and anisocoric pupils. Laboratory findings revealed low hemoglobin level with normal platelet count and prolonged PPT and aPTT. Head CT Scan showed subdural hemorrhage and brain edema. Both were treated conservatively with series of FFP transfusion, intramuscular vitamin K injection, and PRC transfusion. After their conditions improved, both were then referred for operative management and are now recovering well after the surgery.
Learning Points/Discussion : Late VKDB is most common in exclusively breastfed infants who have received no or inadequate vitamin K prophylaxis after birth. This report shows the rare occurrence of late VKDB, manifesting as subdural hemorrhage, in healthy infants who have received intramuscular vitamin K prophylaxis after birth. Both infants also have no other predisposing conditions that can cause vitamin K deficiency, suggesting that the definite cause of the case is still unknown. This report suggests that there's potential risk of developing late VKDB even after receiving vitamin K injection at birth. More research is needed to evaluate how the prophylaxis failed to prevent late VKDB from occurring. Early recognition, diagnosis and prompt treatment are also important, as they will result in a better outcome and prognosis.
Keywords: Late VKDB Subdural Hemorrhage Vitamin K Prophylaxis