Letter to the Editor

Vitamin K Deficiency Bleeding after Missed Prophylaxis: Rapid Synergistic Effect of Vitamin K Therapy on Hemostasis

Authors: Paul Clarke, MB, FRCPCH, Martin J. Shearer, PhD, MRCPath

Abstract

To the Editor:


We thank Drs. Hubbard and Tobias for their fascinating report of two infants with devastating intracerebral bleeding,1 and Dr. Waseem for his accompanying editorial.2 These cases of hemorrhagic disease of the newborn, now better termed vitamin K deficiency bleeding (VKDB),3 are tragic but most instructive. The series of four warning bleeds suffered by Patient 1 in the weeks leading up to its catastrophic intracranial bleed was startling. Warning bleeds are frequent harbingers of late VKDB3,4 but presumably went unrecognised in this patient because of the rarity of VKDB in the US. Appreciation of warning bleeds and prompt action could prevent significant morbidity and mortality.

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References

1. Hubbard D, Tobias JD. Intracerebral hemorrhage due to hemorrhagic disease of the newborn and failure to administer vitamin K at birth. South Med J 2006;99:1216–1220.
 
2. Waseem M. Vitamin K and hemorrhagic disease of newborns. South Med J 2006;99:1199.
 
3. Sutor AH, von Kries R, Cornelissen EA, et al. Vitamin K deficiency bleeding (VKDB) in infancy. ISTH Pediatric/Perinatal Subcommittee. International Society on Thrombosis and Haemostasis. Thromb Haemost 1999;81:456–461.
 
4. McNinch AW, Tripp JH. Haemorrhagic disease of the newborn in the British Isles: two year prospective study. BMJ 1991;303:1105–1109.
 
5. Sutor AH, Künzer W. Time interval between vitamin K administration and effective hemostasis. In: Suzuki S, Hathaway WE, Bonnar J, et al (eds). Perinatal Thrombosis and Hemostasis. Tokyo, Springer-Verlag, 1991, pp 257–262.
 
6. Office for National Statistics (2006). Birth Statistics. Review of the Registrar General on births and patterns of family building in England and Wales, 2005, series FM1 no. 34. London: HMSO. Available at: http://www.statistics.gov.uk/downloads/theme_population/FM1_34/FM1_no34_2005.pdf. Accessed January 29, 2007.
 
7. McNinch AW, Tripp JH.Vitamin K deficiency bleeding. London: British Paediatric Surveillance Unit, 17th Annual Report, 2002–2003, pp 31–32. Available at: http://www.bpsu.inopsu.com/publications/annual_reports/annual-report_2003.pdf. Accessed January 29, 2007.