Presenter Status
Fellow
Abstract Type
Case Report
Primary Mentor or Principal Investigator
Micheal Silvey, MD
Presentation Type
Poster
Start Date
21-5-2026 11:00 AM
End Date
21-5-2026 12:00 PM
Abstract Text
Background: Vitamin K deficiency can present as bleeding in infants due to the inability to produce clotting factors needed for sufficient hemostasis. Newborns have sterile gut microbiomes and do not absorb large amounts of vitamin K. Additionally, vitamin K is transferred poorly via the placenta, leading to limited vitamin K stores.
Objective: To describe an infant presenting with severe anemia and shock from bleeding after a common procedure because of vitamin K deficiency.
Methods: Single case report results
Results: 5-week-old term male presented to the emergency department (ED) in respiratory distress. Infant was born at home and did not receive hepatitis B vaccination or vitamin K. Infant had history of an upper labial frenulotomy performed a few days prior to presentation, complicated by bleeding and oozing at the procedure site. In the ED infant was found to be in severe respiratory distress, tachycardic, and with pale oral mucosa and bruising noted on his back. Laboratory studies were significant for a mixed respiratory and metabolic acidosis, leukocytosis (27), severe anemia (3.4), hyponatremia, severe coagulopathy with PT >125 seconds and aPTT 96.5 seconds, and hyperbilirubinemia. Infant was admitted to the pediatric intensive care unit (PICU) intubated in shock secondary to severe anemia and coagulopathy. During PICU course, infant was found to have a grade 1 interventricular hemorrhage on head ultrasound. MRI brain showed scattered supratentorial foci consistent with parenchymal hemorrhage without any ischemia and a small subarachnoid hemorrhage. No neurosurgical intervention was indicated, and continuous EEG monitoring showed no seizure activity. The severity of his anemia and coagulopathy prompted transfusion with 4 units of packed RBCs and fresh frozen plasma, which contributed to a transfusion-associated lung injury (TRALI), requiring temporary escalation of respiratory support. Vitamin K deficiency was highly suspected given history of vitamin K refusal, post-procedural bleeding, and oozing at procedure site prior to presentation. Vitamin K supplementation was given with a total of 3 doses administered over 3 days. After transfusions and vitamin K supplementation, coagulopathy resolved with repeat PT, aPTT, and fibrinogen being normal for age. Anemia improved to hemoglobin of 11.9 and infant was discharged on no respiratory support, fully breast feeding, and on vitamin D supplementation.
Conclusions: Vitamin K deficiency should be considered in any infant with history of refusal of vitamin K supplementation and bleeding.
5-Week-Old Male Presenting With Severe Anemia and Coagulopathy: A Case Report
Background: Vitamin K deficiency can present as bleeding in infants due to the inability to produce clotting factors needed for sufficient hemostasis. Newborns have sterile gut microbiomes and do not absorb large amounts of vitamin K. Additionally, vitamin K is transferred poorly via the placenta, leading to limited vitamin K stores.
Objective: To describe an infant presenting with severe anemia and shock from bleeding after a common procedure because of vitamin K deficiency.
Methods: Single case report results
Results: 5-week-old term male presented to the emergency department (ED) in respiratory distress. Infant was born at home and did not receive hepatitis B vaccination or vitamin K. Infant had history of an upper labial frenulotomy performed a few days prior to presentation, complicated by bleeding and oozing at the procedure site. In the ED infant was found to be in severe respiratory distress, tachycardic, and with pale oral mucosa and bruising noted on his back. Laboratory studies were significant for a mixed respiratory and metabolic acidosis, leukocytosis (27), severe anemia (3.4), hyponatremia, severe coagulopathy with PT >125 seconds and aPTT 96.5 seconds, and hyperbilirubinemia. Infant was admitted to the pediatric intensive care unit (PICU) intubated in shock secondary to severe anemia and coagulopathy. During PICU course, infant was found to have a grade 1 interventricular hemorrhage on head ultrasound. MRI brain showed scattered supratentorial foci consistent with parenchymal hemorrhage without any ischemia and a small subarachnoid hemorrhage. No neurosurgical intervention was indicated, and continuous EEG monitoring showed no seizure activity. The severity of his anemia and coagulopathy prompted transfusion with 4 units of packed RBCs and fresh frozen plasma, which contributed to a transfusion-associated lung injury (TRALI), requiring temporary escalation of respiratory support. Vitamin K deficiency was highly suspected given history of vitamin K refusal, post-procedural bleeding, and oozing at procedure site prior to presentation. Vitamin K supplementation was given with a total of 3 doses administered over 3 days. After transfusions and vitamin K supplementation, coagulopathy resolved with repeat PT, aPTT, and fibrinogen being normal for age. Anemia improved to hemoglobin of 11.9 and infant was discharged on no respiratory support, fully breast feeding, and on vitamin D supplementation.
Conclusions: Vitamin K deficiency should be considered in any infant with history of refusal of vitamin K supplementation and bleeding.
Comments
Poster Board Number: 1