Recurrent Intracranial Bleed in 3 Siblings: Short of a Shot of Vitamin K!

Abstract

We present a family who suffered recurrent sibling losses due to vitamin K deficiency bleed. The index child was asymptomatic at presentation, had normal clinical examination, and was investigated for coagulation disorders in view of previous 3 sibling losses as a result of intracranial hemorrhage. His investigations showed deranged coagulogram and clotting factors’ assay. The baby was given vitamin K1 1 mg intramuscularly following which his coagulogram and clotting factors’ assay returned to normal. The genetic analysis did not identify any inherited cause of bleeding tendency. The significant family history, exclusive breastfeeding, no diarrhea, failure to thrive or drug use, no prophylaxis with vitamin K at birth, recovery of clotting factors on vitamin K administration, and a corroborative molecular analysis confirmed diagnosis of vitamin K deficiency in the index child. This case gives a strong reminder not to miss birth dose of vitamin K in any neonate.

Late-Onset Vitamin K Deficiency Bleeding: A Preventable Pathology

“…We have read with great interest the article recently published in this journal by Mahajan et al1 “Recurrent Intracranial Bleed in 3 Siblings: Short of a Shot of Vitamin K.” In this article, the authors mention that late bleeding because of vitamin K deficiency is a rare disease with an incidence of between 4.4 and 72 per 100,000 inhabitants, which is similar to that reported in the medical literature 2,3. Vitamin K plays an essential role in activating coagulation factors II, VII, IX, and X.…”

“…Vitamin K plays an essential role in activating coagulation factors II, VII, IX, and X. Therefore, its deficiency can generate bleeding that, in the most severe cases, can lead to the death of neonates, as described in the manuscript of Mahajan et al1 We are struck by the family history of the absence of vitamin K prophylaxis in the 3 newborns since several clinical practice guidelines recommend using prevention in this type of population, as it results in a cost-effective strategy 3–5. It is true that the prophylaxis strategy with vitamin K is not routine in all countries and that its dose and administration route are not unified.…”

“…Finally, we thank to Mahajan et al1 for reminding us of this critical pathology, and we want to emphasize the preventable nature of the pathology, being necessary to detect it mainly if prophylaxis has not been applied, through clinical questioning; identifying the reason for the absence of prevention and of course administering the treatment to avoid sequelae, disability, and even death in affected neonates.…”