Vitamin-K-Mangel-Blutung

A 3-month-old male infant was admitted to hospital due to fever of up to 38.5 °C. He had been drinking less than usual and the urine was dark colored, possibly bloody. The medical history was unremarkable, he had been vaccinated according to the recommendations and had received all recommended check-ups. On admission, he was in a stable condition but showed a pale skin color and was relatively sleepy during the examination. The fontanelle was soft and level and there were no petechiae or signs of active bleeding. The laboratory results revealed elevated inflammatory values, a low hemoglobin value of 6.9 mg/dl and a Quick value < 5%. The vitamin K‑dependent coagulation factors were significantly reduced. Transfontanelle ultrasonography revealed a large echo-rich mass on the left side with midline displacement. Coagulation was improved prior to emergency neurosurgical relief. Postoperatively, the infant showed one possible convulsive event but otherwise showed a positive development. A check-up 2 weeks after discharge again revealed an unmeasurably low Quick value and a subdural hematoma was seen on cranial magnetic resonance imaging (MRI) which was treated conservatively. He was closely monitored. All diagnostics, including pancreatic elastase, activated protein C (APC) resistance, methylenetetrahydrofolate reductase (MTHFR) gene and prothrombin mutations as well as testing for vitamin K epoxide reductase deficiency showed normal results. The infant had received the recommended vitamin K prophylaxis of 2 mg p.o. While intramuscular administration can almost completely prevent classical and late vitamin K deficiency bleeding, this form of application is reserved for newborns in a critical condition, such as preterm infants. In a child with suspected vitamin K deficiency bleeding, individual analysis of vitamin K-dependent coagulation factors (e.g., II and V) enables a distinction to be made between vitamin K deficiency and liver insufficiency. In vitamin K deficiency a prolonged prothrombin time and a reduced Quick value are found while platelets are normal. An increase in vitamin K‑dependent proteins and the Quick value can be measured 30 min after intravenous administration of vitamin K. While vitamin K deficiency bleeding is rare, it should still be considered in infants with intracranial hemorrhage or other bleeding incidents, such as bleeding after circumcision or other interventions.