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Risk factors of bleeding diathesis secondary to low prothrombin complex level in infants: a preliminary report
B J Pansatiankul1, S Ruengsuwan, J Lektrakul
1Children's Hospital, Bangkok, Thailand.
Insights
Infants with low prothrombin complex levels experienced severe bleeding disorders, particularly intracranial hemorrhage, with significant mortality and long-term neurological damage. Exclusive breastfeeding was identified as a key risk factor.
Area of Science:
- Pediatrics
- Hematology
- Neonatology
Background:
- Bleeding disorders in infants can stem from low prothrombin complex levels.
- Vitamin K-dependent coagulation factors (II, VII, IX, X) are crucial for hemostasis.
Purpose of the Study:
- To investigate bleeding disorders in infants with low prothrombin complex levels.
- To identify clinical manifestations, outcomes, and risk factors associated with these bleeding disorders.
Main Methods:
- A case-control study involving 20 infants with bleeding disorders and 60 matched controls.
- Analysis of coagulation factor levels, clinical presentations, bleeding sites, and neurological outcomes.
Main Results:
- Infants presented with prolonged partial thromboplastin and prothrombin times, and low levels of vitamin K-dependent factors.
- Intracranial hemorrhage was prevalent (95%), leading to high rates of mortality (10%) and permanent brain damage (45%).
- Exclusive breastfeeding was a significant risk factor (OR = 7.0, p < 0.005).
Conclusions:
- Low prothrombin complex levels cause severe bleeding disorders in infants, with significant morbidity and mortality.
- Intracranial hemorrhage is a major complication, and exclusive breastfeeding is a modifiable risk factor.
- Prompt diagnosis and management are critical to improve outcomes and prevent neurological sequelae.
Abstract:
Twenty infants aged 2 weeks to 3 months with the diagnosis of bleeding disorder secondary to low prothrombin complex level were studied. Sixty children of the control group were matched to the cases by age +/- 2 weeks, sex and race. The ratio of boys to girls was 2.3:1. The median, mean, and range of age of the cases and controls were 43.5 days, 43.7 days, 21-73 days and 43.5 days, 46.8 days, 26-28 days respectively. Most of them were pale with a mean hematocrit of 23.55%. The partial thromboplastin time and prothrombin time were markedly prolonged. The means of vitamin K dependent coagulation factors II, VII, IX and X were 1.10%, 5.87%, 2.86%, and 4.47% of adult activity, respectively. The clinical manifestations related to the bleeding of the cases were drowsiness and convulsion (95%), pallor (85%), and apparent bleeding (10%). The sites of the bleeding were demonstrated in the cranial cavity (95%), gastrointestinal tract and oral cavity (15%), and skin (5%). Nineteen patients with intracranial hemorrhage had bleeding in the subdural space (79%), intracerebral (42%), intraventricular (32%), and subarachnoid space (5.2%). The mortality rate and permanent brain damage occurred in 10% and 45%, respectively. Only 45% of the cases recovered normally. The permanent neurological sequelaes were hemiparesis (44.4%), microcephaly (33.3%), convulsive disorder (33.3%), mental retardation (33.3%), spasticity (22.2%), and hydrocephalus (11.1%). Breast feeding alone up to the day of study (OR = 7.0, p < 0.005) was found to be a significant risk factor for bleeding in these infants.(ABSTRACT TRUNCATED AT 250 WORDS)