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

• Published in: BMJ case reports Vol. 17; no. 8; p. e261126
• Main Authors: Azar, Justin M, Lambert, Richard, Maffei, Frank Anthony, Thomas, Tessy A
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd 08.08.2024; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Acidosis; Anesthesia; Blood; Breast Feeding; Case Report; Case reports; Childbirth & labor; Congenital diseases; Delirium; Disease prevention; Emergency medical care; Haematology (incl blood transfusion); Hematology; Hemoglobin; Hemorrhage; Hemorrhagic shock; Hospitals; Humans; Hyperglycemia; Infant; Infant health; Injections, Intramuscular; Male; Metabolism; Multiple Organ Failure - etiology; Neonatal and paediatric intensive care; Newborn babies; Paediatrics; Pediatrics; Preventative pediatrics; Routine care of the full-time infant; Sepsis; Shock, Hemorrhagic - etiology; Systemic diseases; Thymus gland; Treatment Refusal; Ultrasonic imaging; Venous access; Ventilators; Vitamin K - administration & dosage; Vitamin K - therapeutic use; Vitamin K Deficiency - complications; Vitamin K Deficiency Bleeding - diagnosis; United States > US; Preventative pediatrics; Routine care of the full-time infant; Neonatal and paediatric intensive care; Haematology (incl blood transfusion); Infant health
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2024-261126

Vitamin K is an essential dietary cofactor required for the synthesis of active forms of vitamin K-dependent procoagulant proteins. Vitamin K deficiency, particularly late-onset deficiency occurring between 1 week and 6 months of age, can cause a life-threatening bleeding disorder. An exclusively breastfed, full-term, 6-week-old infant male presented with severe haemorrhagic shock and multi-system organ failure related to caregiver refusal of intramuscular vitamin K after birth. Coagulation studies were normalised within 8 hours of intramuscular vitamin K administration. An increasing number of caregivers are refusing intramuscular vitamin K which has led to a rise in the incidence of vitamin K deficiency bleeding. Health policy organisations around the world emphasise the benefits of intramuscular vitamin K and risks of refusal, particularly in exclusively breastfed infants who are at higher risk due to low vitamin K levels in breast milk. This case highlights the multi-system severity of this life-threatening yet preventable disorder.