Discusso anche su MedShr: ipotesi DVK
Un solo commento ha fatto riferimento alla possibilità di considerare nella diagnosi differenziale il deficit di vit K (DVK)
2 min readMar 31, 2017
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Hypothesis (2): VKDB — Only one of the comments have considered a vitamin K deficiency bleeding (VKDB).
This was a very remote diagnostic possibility in this patient, who at 8 months of age would be very old to develop VKDB, but…
“A life-threatening consideration in the differential diagnosis is vitamin K deficiency bleeding (VKDB). Vitamin K, a lipophilic cofactor required for activation of multiple clotting factors, is neither stored in the neonatal liver nor readily synthesized in neonates due to underdeveloped gut flora. In the last several decades, the routine administration of prophylactic parenteral vitamin K to newborns has reduced the incidence of VKDB. VKDB is classified by 3 periods of onset: early (initial 24 hours after birth), classic (up to 2 weeks postnatally), and late (beyond 2 postnatal weeks). Infants who have not received vitamin K prophylaxis at birth are at high risk. (…)The presentation of VKDB varies, ranging from bleeding at the umbilicus, circumcision, or surgical sites to bleeding at mucosal surfaces and intracranial hemorrhage. Evaluation for children who have these presentations includes an accurate and thorough neonatal history and coagulation studies. Increased prothrombin time with normal partial thromboplastin time, platelet count, and fibrinogen value is highly suspicious for VKDB. Treatment should not be delayed; parenteral vitamin K should be administered immediately” (1)
(1) DOI: 10.1542/pir.2015–0119
Visual Diagnosis: Infant with Ecchymoses
Rebecca Butterfield, Bhavita Patel
Pediatrics in Review Oct 2016, 37 (10) e41-e44;