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Preeti
I am a final yr medical student and i just love ur website!!! I regularly use it to help me with my preparations. The topics are so lucidly written and easily understood with up to date information.. Even the HIV related web site ( www.hivinchildren.org) by Dr.Ira Shah is just fabulous!!! |
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Dr Parang N Mehta
Dear Dr Ira Shah, Congratulations on putting up an excellent website, which will be of great use to practicing pediatricians everywhere. You have achieved the near impossible in getting some of the biggest names in pediatrics in India to contribute content to your site. |
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| Sailala
An excellent website!! good and useful information! Many Thanks for to u all! |
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Sujatha
Very informative site, and queries are getting resolved immediately. Thanks |
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Uttam Laisram
I found the Vaccine Reminder feature on your Website very interesting. My request is that this useful facility may not be restricted to Registered Users, but may be made available to all Visitors, who may like to enter their child's details and take a print-out of the Vaccine schedule. Please consider. Keep up the excellent work in providing India-relevant information for child care. |
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Dr Ira Shah
M.D, DNB, DCH(Gold Medalist), FCPS
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Deficiency of Vitamin K, a fat-soluble vitamin leads to bleeding manifestations.
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Types of vitamin K Deficiency states:
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Early hemorrhagic Disease of Newborn (Early HDN) - This results in severe and life threatening bleeding (scalp hematoma, intracranial or intrabdominal bleeds) at the time of delivery or during the first 24 hours after birth. It occurs in infants whose mothers have taken drugs such as anticonvulsants, antituberculous drugs, salicylates or coumarin anticoagulants that affect Vitamin K metabolism.
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Classical HDN - It occurs in 1st week of life and presents as generalized ecchymosis, bleeding from umbilical stump, GI bleed or epistaxis. It is found in healthy term babies who are exclusively breastfed and have not received Vitamin K prophylaxis.
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Late HDN - This occurs between 2-12 weeks of age and may even present upto 1 year of age. It may be idiopathic (occurs between 2-12 weeks of age) or secondary (can occur anytime in the 1st year) due to chronic diarrhea, prolonged use of broad-spectrum antibiotics, cystic fibrosis, biliary atresia, cholestatic hepatitis, celiac disease and chronic warfarin exposure. In idiopathic cases, immaturity of the carboxylase system in the liver has been postulated as the etiological cause. Intracranial bleeds and wide spread ecchymoses are the commonest presenting features. GI or mucosal bleeds or excessive bleeding following IM injections may be infrequent manifestations.
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Vitamin K functions- Vitamin K is necessary for production of carboxylated Factor II, VII, IX and X in the coagulation cascade system. Vitamin K deficiency results in non-functional (qualitative) deficiency of above-mentioned factors.
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Sources of vitamin K - Vitamin K occurs in plants and green leafy vegetables as phylloquinone (Vitamin K1). It is also produced as menaquinone (Vitamin K2) endogenously in the gut by bacteria. Menaquinones are not found in significant amount in the liver till about 2 weeks of age. Human milk is a poor source of vitamin K.
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Diagnosis of Vitamin K deficiency - Vitamin K deficiency is associated with markedly prolonged partial thromboplastin time (PTT) and Prothrombin time (PT) with normal thrombin time, fibrinogen and platelet count.
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Presence of PIVKA (proteins induced In vitamin K absence- These are non carboxylated forms of Vit K dependent factors) is a highly sensitive & specific marker. PIVKA- II (Non carboxylated form of prothrombin) is the most sensitive parameter. PT becomes normal as early as 4 hours after administration of vitamin K whereas PIVKA-II has a plasma disappearance time of 70 hours.
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Treatment of vitamin K deficiency-
Prevention- A single intramuscular dose (0.5 to 1mg) of vitamin K administered at birth protects against classical HDN and idiopathic late onset HDN upto 3 months of age. Patients receiving TPN should be given biweekly parenteral Vitamin K and those receiving broad-spectrum antibiotics should receive weekly supplementation because of sterilization of the gut. Mothers with "at risk” babies of early HDN should receive prophylactic Vitamin K (20mg orally) daily during last 2 weeks of pregnancy or 10mg orally daily during last 2 months of pregnancy.
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Treatment of Vitamin K bleeding manifestation - When deficiency is severe intramuscular administration of Vitamin K may be associated with hematoma formation and may delay the therapeutic response. Hence IV route is preferred.
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References
- Lane PA, Hathaway WE - Vitamin K in infancy. J Pediatrics 1985,106; 351-359.
- Liebman HA, Furie BC, Furie - Hepatic Vitamin K dependent carboxylation of blood clotting proteins, Hepatology- 1982, 3: 488-494.
- Cornellssen EAM, Kollee IAA, DeAbrell RA et al - Effects of oral and intramuscular Vitamin K prophylaxis on Vitamin K1, PIVKA- II and clotting factors in breast-fed infants. Arch Dis Child 1992, 67: 1250-1254.
- Deblay MF, Vert P, Andre M et al - Transplacental Vitamin K prevents hemorrhagic diseases of the infant of epileptic mother. Lancet 1982, 1:1247.
Last Updated on 11-08-2007
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