Late-onset vitamin K deficiency presenting as haemorrhagic shock and severe multi-system organ failure

Area of Science:

• Pediatrics
• Hematology
• Public Health

Background:

• Vitamin K is essential for synthesizing active vitamin K-dependent procoagulant proteins.
• Vitamin K deficiency bleeding (VKDB) is a serious condition, especially late-onset VKDB in infants (1 week to 6 months).
• Exclusively breastfed infants are at higher risk due to low vitamin K levels in breast milk.

Observation:

• A 6-week-old exclusively breastfed infant male presented with severe hemorrhagic shock and multi-system organ failure.
• This critical condition was linked to caregiver refusal of routine intramuscular vitamin K at birth.
• Coagulation studies normalized within 8 hours of administering intramuscular vitamin K.

Findings:

• A rise in VKDB incidence is observed, correlating with increased caregiver refusal of intramuscular vitamin K.
• Health organizations worldwide stress the benefits of intramuscular vitamin K and the risks associated with its refusal.
• Infants, particularly those exclusively breastfed, face elevated risks of VKDB due to insufficient vitamin K intake.

Implications:

• This case underscores the potentially multi-system, life-threatening severity of preventable VKDB.
• It highlights the critical importance of universal vitamin K prophylaxis for all newborns.
• Healthcare providers must counsel caregivers on the risks of vitamin K refusal and the benefits of prophylaxis.