Vitamin K Deficiency Bleeding(VKBD) along with raised PIVKA-II Levels

A report describes a case of a term neonate born who developed ecchymosis for two days, heeded by altered sensorium and seizures on day 25 of life. He had an uneventful perinatal transition and was exclusively breastfed. 

The patient had received an intramuscular Vitamin K (1 mg) at birth and a repeat dose before referral. Examination revealed bilateral grade III intraventricular hemorrhage, anemia, dyselectrolytemia, ecchymosis, and normal platelet count and coagulation. He was administered blood products and antiseizure medication. Laboratory investigation revealed high protein induced by vitamin K absence-II (PIVKA-II). The patient was administered twice weekly Vitamin K (parenteral followed by oral) for 6 wk. He showed delayed milestones and spasticity at three months of follow-up and required ventriculoperitoneal shunt placement.

It was hypothesized that exclusive breastfeeding could have caused VKDB in the index case, which was diagnosed by elevated PIVKA-II levels - a highly specific marker.

Kumar C, Marda S, Pothala R. et al. Late Onset, Vitamin K Deficiency, Bleeding in a Neonate and Role of Elevated PIVKA-II Levels. Indian J Pediatr.2024.