(HealthDay News) — Fussy infants with unexplained bruising or bleeding may have late-onset vitamin K-deficient bleeding (VKDB) as a result of parental refusal of the vitamin K injection at birth, according to a case report published in the July issue of the Journal of Emergency Medicine.
Karyn L. Kassis, MD, MPH, from the Nationwide Children’s Hospital in Columbus, Ohio, and colleagues discuss the case of a 10-week-old boy presenting to the emergency department with gradual increase in fussiness and new onset of blood flecks in stool.
The researchers note that careful physical examination revealed a pale infant, with moist and pale appearing mucous membranes. A complete blood count demonstrated profound anemia, with hemoglobin of 5.6g/dL and hematocrit of 17.6%. On re-examination, the patient was found to have bruising, petechiae, and persistent oozing at the blood draw site that were not present on initial examination. The mother revealed that the family refused immunizations and vitamin K injection at birth, leading to suspected diagnosis of late-onset VKDB. The infant was given intravenous fresh frozen plasma and vitamin K, as well as transfused red blood cells, after which, coagulation factors quickly normalized.
“Emergency medicine providers need to add this serious treatable disease into their diagnostic consideration for fussy infants, infants with unexplained bruising or bleeding, or infants with new-onset seizures,” the authors write. “Rapid identification of VKDB can lead to prompt treatment and halt the rapid progression of symptoms.”