Vitamin K deficiency bleeding (VKDB) previously known as hemorrhagic disease of the newborn has been classified as Early (0-24hrs), Classic (2-7 days) and Late (1-6 months). Child birth following the maternal ingestion of anti-epileptic drugs such as Phenytoin, is liable to result in early VKDB as well as bone changes in the fetus. Other maternal risk factors for VKDB include medications such as warfarin and antibiotics.
Failure to administer vitamin K at birth, prematurity, infective gastro-enteritis, the administration of antibiotics, malabsorption, liver disease, prolonged breast feeding, and malnutrition as shown by hypoabuminemia have all been associated with VKDB. In view of the pivotal role of vitamin K in hemostasis and osteogenesis it is postulated that the bleeding, bruising and fractures seen in some children thought to be nonaccidental injuries such as Shaken Baby or Shaken Impact Syndrome, could be due to a deficiency of vitamin K.
To investigate this possibility the reports of three affected children were examined. It was found that the coagulation screen showed an increase in the prothrombin time, a normal partial thromboplastin time, a normal or slightly increased level of platelets and an absence of a family history of bleeding – findings consistent with vitamin K deficiency. It is concluded that the lesions hitherto attributed to non-accidental injury are in some cases due to a deficiency of vitamin K alone, and others occur in combination with vitamin C deficiency which is a well documented cause of “battered baby”.
Vitamin K deficiency is best detected by the Protein Induced by vitamin K absence/abnormality (PIVKA -II) test rather than the prothrombin time and by the serum under-carboxylated osteocalcin test which provides the best guide to the state of mineralization of bone and hence the tendency to fracture. A name change to vitamin K deficiency disease would accommodate both the blood and bone lesions found in this condition when vitamin K alone is shown to be the cause.
Vitamin K Deficiency Disease