Abstract:
Background: The incidence of early-onset vitamin K deficiency bleeding (VKDB) in at-risk
neonates who did not receive vitamin K supplementation varied from 6 to 12%. This case report
aims to show that VKDB can occur abruptly after birth despite vitamin K1 1 mg IM being given
immediately after birth.
Case presentation: A term female baby was born through vaginal delivery of a 28 years old
mother, G1P0A0, 39–40 weeks gestation with normal APGAR score, and birth weight was 3445
g, birth length was 52 cm. During pregnancy, the mother did not take any drugs except vitamins.
There are no abnormalities on the baby’s physical examination. The anus is patent. Immediately
after birth, the baby received a vitamin K1 1 mg intramuscularly. Abruptly, 50 min after
delivery, there was meconium with lots of fresh blood. Laboratory results showed hemoglobin,
19.6 g/dL; leukocytes, 25,010/uL; platelets, 390,000/uL, with increased PT and aPTT. A
peripheral blood smear showed a normal blood morphology. When 7 h old, the baby had much
hematochezia. Laboratory results showed decreased hemoglobin to 17.5 g/dL and increased PT,
aPTT, and INR. No abnormalities were found on the babygram and abdominal ultrasound. The
working diagnosis was gastrointestinal bleeding due to idiopathic early-onset VKDB. The baby
received vitamin K1 2 mg IM, Fresh Frozen Plasma, and a Packed Red Cells transfusion. The
patient returned home in good clinical condition.
Conclusion: Vitamin K1 1 mg IM prophylaxis should be given immediately after birth to
prevent early-onset VKDB. In addition, pregnant women who receive drugs that interfere with
vitamin K metabolism (anti-epileptic drugs, antituberculosis drugs, vitamin K antagonist drugs)
should be given prophylactic vitamin K1, 20 mg/d orally, for at least two weeks before the
expected time of delivery.
Keywords: Gastrointestinal bleeding, Vitamin K deficiency bleeding, Early-onset, Idiopathic,
Case report
