A Bleeding Syndrome in Infants due to Acquired Prothrombin Complex Deficiency

Abstract

A bleeding syndrome due to severe prothrombin complex deficiency is reported in 93 infants. Most were breast fed (98 per cent), aged 2 weeks to 1 year and there were no serious preceding or associated diseases. Hemorrhagic diathesis, pallor and mild hepatomegaly were the major manifestations. The incidence of intracr anial bleeding was strikingly high (63 per cent) particularly with subdural and subarachnoid hemorrhage. Acute onset, short course and rapid clinical and laboratory improvement after vitamin K therapy were observed. Mortality rate was 35 per cent but has been reduced to 17 per cent since 1969. The location of bleeding, prompt diagnosis and early treatment are the major factors affecting prognosis. Severe prothrombin complex deficiency due to vitamin K deficiency accounted for the pathogenesis of bleeding. Possible causes of vitamin K deficiency were discussed but definite conclusions could not be drawn.

Studies on Vitamin K-Dependent Factor Deficiency during Early Childhood with Special Reference to Prothrombin Activity and Antigen Level

“…Platelet count and liver function tests were normal as reported by others [Bhanchet et al, 1966;Whitaker zi al., 1969], Previous studies have also recorded normal levels of factor V and VIII, normal thrombin time, no evidence of fibrinolysis or anticoagulant, and vitamin C was normal in the few cases tested [Bhanchet and Kashemsant, 1975], It is noteworthy that intracranial hemor rhage was observed in 1 of the 3 cases with congenital bile duct atresia. This might indi cate that the disposition to intracranial hem orrhage is related to the age rather than to a peculiarity of the 'new' syndrome.…”

“…Since the reports of Bhanchet et al [1966] and Goldman and Desposito [1966] describ ing a 'new' bleeding syndrome in infants from the age of 2 weeks up to 1 year, several publications have appeared presenting the syndrome under a variety of descriptive terms such as 'hemorrhagic syndrome of early childhood' [Lovric and Jones, 1967], 'hemorrhagic diathesis in children associated with vitamin K deficiency' [Taj-Eldin et al" 1966] and 'vitamin K deficiency in infants beyond the neonatal period' [Nammacher et al, 1970]. In 1975, Bhanchet and Kashemsant gave a review of 240 cases from eight laboratories.…”

Correlation between maternal milk and infant serum levels of chlorinated pesticides (CP) and the impact of elevated CP on bleeding tendency and immune status in some infants in Egypt

“…Many hydroxychlorobiphenyls are effective hemolytic agents; in contrast, the parent chlorobiphenyls are generally quite ineffective at inducing hemolysis. The hemolytic potencies of hydroxychlorobiphenyls vary with degree of chlorination and, more importantly, with the position of their chloro-and hydroxy-substituents (Bhanchet et al, 1977).…”

The second nation-wide survey in Japan of vitamin K deficiency in infancy

“…In 1977, Bhanchet et al [2] reported 93 infants with severe prothrombin complex deficiency. Later Lane et al…”