LATE FORM OF VITAMIN-K-DEFICIENCY BLEEDING IN GERMANY

Background The evaluation of the disease of vitamin K deficiency bleed ing (VKDB). Method 108 reported cases between 1980 and 1990 from Germa ny. Results VKDB occurs preferentially (90%) in fully breastfed infant s, males are affected nearly twice as often as females. The peak age i s four weeks; the majority (79%) of the infants are between three and seven weeks old. 58% of the patients suffer from intracranial bleeding , which results in a total mortality rate of 19% and in neurological d amage in 21%. Generally the VKDB occurred suddenly as no warning signs were noticed or they were so insignificant as not to be heeded. In,at least 37% of the patients cholestasis was detected. The Quick value w as pathologically low in every case. Vitamin K dependent factors were low and PIVKA was detectable, whereas vitamin K independent hemostatic parameters were normal or even elevated. The combination of low Quick value and normal fibrinogen as well as platelet level is a goad diagn ostic indicator which can be confirmed by administration of vitamin K, after which the Quick value will rise within 30 minutes. Vitamin K pr ophylaxis reduces the incidence of VKDB from 5.13 per 100 000 births t o a tenth of that; single dose oral prophylaxis reduces the risk by a factor of 3.3 and a single parenteral dose by 14.3. Parenteral prophyl axis is more effective in patients with hepatobiliary disorders. Patie nts who suffered VKDB despite having received vitamin K prophylaxis ar e older at onset (without prophylaxis 32 days, with oral prophylaxis 3 7 days, and with parenteral prophylaxis 63 days) and have less intracr anial bleeding (35%) than patients who received none (62%). Conclusion Late form of VKDB is a rare but serious disease which can be prevente d by VK-prophylaxis.