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Vitamin K deficiency in diarrhoea
R Kumar1, N Marwaha, R K Marwaha
1Division of Pediatric Hematology-Oncology, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Chandigarh-160012.
Insights
Infants with diarrhea frequently experience vitamin K deficiency, indicated by a low functional to total prothrombin ratio. This ratio is a more sensitive indicator than prothrombin time alone for identifying deficiency in pediatric patients.
Area of Science:
- Pediatrics
- Hematology
- Nutritional Science
Background:
- Vitamin K deficiency is a concern in infants, particularly those with gastrointestinal issues.
- Diarrheal illnesses can impair nutrient absorption, potentially affecting vitamin K status.
Purpose of the Study:
- To determine the prevalence of vitamin K deficiency in infants presenting with diarrheal illness.
- To compare the diagnostic utility of the functional to total prothrombin ratio versus prothrombin time (PT) in identifying vitamin K deficiency in these infants.
Main Methods:
- Infants were classified into acute, protracted, and intractable diarrhea groups, along with healthy controls.
- Coagulation screening tests, including PT and PTTK, were performed.
- Functional and total antigenic levels of prothrombin were measured to calculate the functional to total prothrombin ratio.
Main Results:
- Prothrombin time (PT) was prolonged in 30% of infants with diarrhea versus 11.1% in controls.
- The functional to total prothrombin ratio was significantly lower in infants with diarrhea (0.65 ± 0.41) compared to controls (1.1 ± 0.26) (p < 0.001).
- A low functional to total prothrombin ratio identified vitamin K deficiency in 57.3% of diarrheal infants, approximately double the rate identified by PT alone.
Conclusions:
- The functional to total prothrombin ratio is a more sensitive marker for detecting vitamin K deficiency in infants with diarrhea than PT.
- The malabsorptive state associated with diarrhea is likely a primary factor contributing to vitamin K deficiency in this population.
- Breastfeeding or prior antibiotic use did not show a significant correlation with vitamin K deficiency in the studied infants.
Abstract:
The study was undertaken to determine the frequency of occurrence of vitamin K deficiency in infants with diarrhoeal illness. Infants were categorized into four groups as follows: A(acute diarrhoea), B(protracted diarrhoea) C(intractable diarrhoea) and D(healthy controls). Screening coagulation tests, PT and PTTK along with estimation of functional activity and total antigenic levels of prothrombin were performed. The ratio of functional to total prothrombin was calculated. PT was prolonged in 30% (24/75) of all infants with diarrhoea as compared to controls where the abnormality was observed in 11.1% infants (2/18). The ratio of functional to total prothrombin was significantly lower in infants with diarrhoea, the mean +/- SD values being 0.65 +/- 0.41 vs 1.1 +/- 0.26. This difference was statistically highly significant (p < 0.001). Low ratio was observed in 57.3% (43/75) infants with diarrhoea. Thus functional to total prothrombin ratio identified approximately twice as many diarrhoeal infants with vitamin K deficiency as compared to PT alone. There was no significant correlation with breast feeding as the only mode of diet, or the prior administration of antibiotics in infants with diarrhoea. The inherent malabsorptive state in diarrhoea may be a major contributory factor.