Vitamin K-deficiency bleeding

Vitamin K is a fat-soluble vitamin cofactor for the activation of factors II, VII, IX, and X in the liver. Almost all neonates are vitamin K-deficient at as a result of (1) insignificant transplacental vitamin K crossover, (2) lack of colonization of the colon by vitamin K-producing bacteria, and (3) inadequate dietary vitamin K intake (especially in breast-fed infants because human milk contains less vitamin K than infant formula or cow s milk). Vitamin K-deficiency bleeding (VKDB) refers to bleeding attributable to vitamin K deficiency within first 6 months of life. It occurs in three general time frames early (0-24 hours), classic (1-7 days), and late (2-12 weeks). Early onset occurs rarely and usually is associated with maternal ingestion of anticonvulsants, rifampin, isoniazid, and warfarin. Classic vitamin K-dependent bleeding usually results from the lack of prophylactic vitamin K administration in... 

Puckett RM, Offringa M. Prophylactic vitamin K for vitamin K deficiency bleeding in neonates. Cochrane Database Syst Rev 2000. 

Over the first 6 weeks of postnatal life, the plasma concentrations of clotting factors gradually rise to the adult level in the meantime, they are at risk of potentially fatal hemorrhage that was formerly called hemorrhagic disease of the newborn and is now known as vitamin K deficiency bleeding in infancy. It is usual to give all newborn infants prophylactic vitamin K, either orally or by intramuscular injection (Sutor et al., 1999). At one time, menadione was used, but, because of the association between menadione and childhood leukemia (Section 5.6.1), phylloquinone is preferred. 

Menadione prophylaxis against vitamin K deficiency bleeding in infancy (Section 5.4.1) has been associated with increased incidence of childhoodleukemia and other cancers. 

Sutor AH, von Kries R, Cornelissen EA, McNinch AW, and Andrew M (1999) Vitamin K deficiency bleeding (VKDB) in infancy. ISTH Pediatric/Perinatal Subcommittee. International Society on Thrombosis and Haemostasis. Thrombosis and Haemostasis 81,456-61. 

Zipursky A. Prevention of vitamin K deficiency bleeding in newborns. Br J Haematol 1999 104 430-A37. 

Due to bleeding risk, individuals on anticoagulant therapy or individuals who are vitamin K-deficient should not take vitamin E supplementation without close medical supervision. Absent of that, vitamin E is a well-tolerated relatively non-toxic nutrient. A tolerable upper intake level of 1,000 mg daily of a-tocopherol of any form (equivalent to 1,500 IU of RRR a-tocopherol or 1,100 IU of all-rac-a-tocopherol) would be, according to the Food and Nutrition Board of the Institute of Medicine, the highest dose unlikely to result in haemorrhage in almost all adults. 

Vitamin K is an essential factor in the production of coagulation proteins within the liver. Elevated clotting times from decreased protein synthesis are indistinguishable from those produced by low vitamin K levels caused by malnutrition or poor intestinal absorption. Vitamin K (phytonadione) 10 mg subcutaneously daily for 3 days can help to establish whether the prolonged bleeding time results from loss of synthetic function in the liver or vitamin K deficiency. 

Chronic use of resins may be associated with increased bleeding tendency due to hypoprothrombinemia associated with vitamin K deficiency. 

The absorption of vitamins K2, which are found mainly in cheese, curd cheese, and natto, is much higher and may be almost complete. Thus the nutritional importance of menaquinones is often underestimated. The vitamin K activity is related to the activation of specific proteins involved in blood clotting and bone metabolism. Clinical vitamin deficiency due to dietary inadequacy is rare or nonexistent in healthy adults, thanks to the widespread distribution of the vitamin K in foodstuffs and the microbiological flora of the gut, which synthesizes menaquinones. Only infants up to 6 months are at risk of bleeding due to a vitamin K deficiency. No data on negative effects of an overdose of vitamin K are found [417]. 

Deficiency of vitamin K A true vitamin K deficiency is unusual because adequate amounts are generally produced by intestinal bacteria or obtained from the diet. If the bacterial population in Ihe gut is decreased, for example by antibiotics, the amount of endogenously formed vitamin is depressed, and can lead to hypoprothrombinemia in the marginally malnourished individual (for example, a debilitated geriatric patient). This condition rcaj require supplementation with vitamin K to correct the bleeding tendency. In addition, certain second generation cephalosporins (for example, cefoperazone, cefamandole, and moxalactam) cause hypoprothrombinemia, apparently by a warfarin-like mechanism. Consequently, their use in treatment is usually supplemented with vitamin K. 

I Newborn Rare In adults Bleeding Rare Vitamin K produced by intestinal bacteria. Vitamin K deficiency common in newborns 1 Parenteral treatment with the vitamin K 1 la recommended at birth 1... 

Inhibition of vitamin K absorption can cause vitamin K deficiency, leading to hypoprothrombinemia and hence to bleeding (4). 

Vroonhof K, van Rijn HJ, van Hattum J. Vitamin K deficiency and bleeding after long-term use of cholestyramine. Neth J Med 2003 61(1) 19-21. 

Patients with severe liver dysfunction are more prone to bruising and bleeding as a result of reduced clotting factor production or vitamin K deficiency. The severity increases with worsening liver function. Bruising and bleeding can also be caused by other coagulation disorders. 

Bleeding disorders, anticoagulant therapy, or vitamin K deficiency... 

Cephalosporins can also destroy certain components of the intestinal microflora, and a vitamin K deficiency leading to bleeding episodes can result. Administration of vitamin K can reverse this bleeding. 

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