Vitamin K deficiency
Introduction
Introduction Vitamin K deficiency is a series of symptoms manifested by vitamin K deficiency. Vitamin K deficiency is a coagulopathy caused by a lack of vitamin K. Newborns born within 1 week of the disease are called neonatal hemorrhagic disease, and those born in infancy are called delayed vitamin K-dependent factor deficiency. The main clinical manifestations are skin hemorrhage, hematemesis, blood in the stool, long-term bleeding at the puncture site, often accompanied by intracranial hemorrhage and pulmonary hemorrhage leading to death, and severe intracranial hemorrhage often left behind. The disease is a common disease in neonates and infancy, and is more common in children who are exclusively breastfed within 3 months and whose mother does not eat vegetables. The onset is rapid, the condition is serious, and it is easy to be misdiagnosed. However, as long as there is sufficient understanding of the disease, the disease is completely preventable. Once the disease is treated as soon as possible, the prognosis is good, such as severe intracranial hemorrhage, the prognosis is poor.
Cause
Cause
The cause of vitamin K deficiency:
Due to the lack of vitamin K.
(1) Insufficient intake
Milk contains less vitamin K. The vitamin K content in human milk is only 1/4 of that in milk, and the amount of vitamin K synthesized in the intestine of breast-fed infants is less. Therefore, infants who are not breast-feeding alone are susceptible to this disease. disease. In addition, children grow fast, require a large amount of vitamin K, and are more likely to suffer from insufficient intake.
(ii) Absorption barriers
Liver, gallbladder, pancreatic diseases such as obstructive jaundice and chronic diarrhea caused by any cause can affect the absorption of fat-soluble vitamin K in the intestine.
(iii) Utilization barriers
Any cause of viral infection, such as damage to liver function, can cause vitamin K-dependent factor synthesis disorders.
(iv) Reduction in synthesis
Long-term oral administration of broad-spectrum antibiotics or sulfonamides reduces the synthesis of vitamin K by inhibiting bacteria in the intestines.
(5) Application of anticoagulant drugs
The anticoagulant drug dicoumarin inhibits carboxylase in the liver and reduces the production of vitamin K-dependent factors. Salicylic acid is a degradation product of dicoumarin and also has a similar effect on dicoumarin, so vitamin K should be added when high dose salicylate is used to treat rheumatism.
Examine
an examination
Related inspection
Cerebrospinal fluid pH value simple thrombin generation test vitamin K vitamin K (VitK, VK) simple thrombin generation test
Diagnosis of vitamin K deficiency:
More common in infants less than 3 months, the majority of human breastfeeders, diarrhea, taking a broad spectrum of antibiotics or sulfa drugs before the disease.
Sudden onset of spontaneous bleeding, such as skin bleeding, ecchymosis, subcutaneous hematoma, especially in the compression site such as the back, lumbosacral, buttocks. Common injection site bleeding, nasal discharge, gastrointestinal bleeding.
Severe cases of intracranial hemorrhage, more common subarachnoid, subdural hemorrhage, ventricular and parenchymal hemorrhage are rare. Intracranial hemorrhage can occur alone without bleeding from other sites. There may be signs of meningeal irritation, acute intracranial hypertension, and hematoma compression neural tissue symptoms caused by brain tissue. Even cerebral palsy, respiratory failure and death. Other clinical symptoms may include anemia, hepatomegaly, and fever.
Screening test
PT extension, APTT extension.
2. Confirmation test
FX, FIX, FVII, prothrombin antigen and activity are reduced.
Diagnosis
Differential diagnosis
Differential diagnosis of vitamin K deficiency:
When a baby has bleeding symptoms within 3 months, the disease should be considered first according to the feeding history, the disease and the history of medication. If vitamin K is applied and the bleeding symptoms improve rapidly within 24 hours and the prothrombin time returns to normal, the diagnosis can be confirmed.
If the disease only shows symptoms of intracranial hemorrhage, and is not accompanied by other parts of the bleeding performance, it is easy to be misdiagnosed as intracranial infections such as encephalitis, meningitis and other diseases. The onset of the disease is sudden, there is no obvious symptoms of infection before the disease, the anemia develops rapidly and severely, and the cerebrospinal fluid is bloody. Combined with laboratory tests and response to vitamin K treatment, it is different from intracranial infectious diseases.
In addition, it needs to be differentiated from congenital clotting factor-deficient diseases such as hemophilia. The latter has a history of repeated bleeding, or a similar medical history among family members, and the unique laboratory characteristics of each disease can be identified.
