Vitamin K Deficiency Bleeding

Overview and Considerations

Caroline W. Burke, MSN, RN, CPNP

Disclosures

J Pediatr Health Care. 2013;27(3):215-221. 

In This Article

Emergency Department Management

In the ED, the initial concern was for an occult infection. Peripheral intravenous (IV) access was obtained, the infant was connected to a cardiac-respiratory monitor, and laboratory samples were sent for evaluation. Initial laboratory tests revealed a white blood cell count of 13,780/mL (normal, 6200–17,000/mL); a red blood cell count of 3.64/mL (normal, 4–6/mL); a hemoglobin of 11.1 g/dL (normal, 10–17 g/dL); a hematocrit of 32.8% (normal, 39%–59%); and a platelet count of 330,000/mL (normal, 200,000–475,000/mL). The urinalysis was unremarkable. Peripheral anaerobic and aerobic blood cultures and a urine culture were sent for analysis. Because of focal neurologic findings and concern for increased intracranial pressure (ICP), a lumbar puncture (LP) was not performed. A computed tomography (CT) scan of the head was obtained, which revealed a large left frontal hemorrhage, large subdural and subarachnoid areas of bleeding, and an 11-cm midline shift with probable left uncal herniation and bilateral occipital infarcts. In light of the CT findings, additional laboratory tests were performed and revealed a prothrombin time (PT) greater than 140 seconds (normal, 11.0–12.5 seconds) and a partial thromboplastin time (PTT) of 117 seconds (normal, 60–70 seconds).

Given this infant's history of no vitamin K administration at birth and prolonged PT, he was given 1 mg of vitamin K intravenously and 10 mL/Kg fresh frozen plasma (FFP) to correct his coagulopathy. A basic metabolic panel, factor panel, and liver function panel studies were obtained; all were within normal range. His factor studies revealed the following: fibrinogen, 286 (normal, 125–300 mg/dL); d-dimer, 666 μg/L (normal, < 250 μg/L); factor II, 54% (normal, 80%–120%); factor V, 166% (normal, 50%–150%); factor VII, 114% (normal, 65%–140%); factor VIII, 162% (normal, 55%–145%); factor IX, 59% (normal, 60%–140%); and factor X, 57% (normal, 45%–155%). The infant was transported to the pediatric intensive care unit for further management.

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