Select a Community
Are you sure you want to trigger topic in your Anconeus AI algorithm?
You are done for today with this topic.
Would you like to start learning session with this topic items scheduled for future?
Deficiency of factor VII
62%
28/45
Deficiency of factor VIII
4%
2/45
Deficiency of von Willebrand factor
7%
3/45
Schistocytes
18%
8/45
Thrombocytopenia
9%
4/45
Select Answer to see Preferred Response
This neonatal patient presents after a home birth with bloody stools, scattered ecchymoses, evidence of an intracranial bleed, and prolonged PT and PTT, which suggests a diagnosis of vitamin K deficiency. Vitamin K deficiency causes a deficiency of factor X, IX, VII, and II. Newborns are at risk of vitamin K deficiency in the first month of life due to poor placental transfer of vitamin K, low levels of vitamin K in breastmilk, gut sterility, and immature liver function. Deficiency of vitamin K will result in low levels of all vitamin K-dependent clotting factors, which include factors II, VII, IX, and X. Standard perinatal care of newborns includes parenteral injection of vitamin K - patients who do not receive this injection are at risk of developing easy bruising, bloody stools, and intracranial hemorrhage. Laboratory studies will reveal prolonged PT and PTT, and the plasma concentrations of vitamin K-dependent clotting factors will be decreased. Figure A demonstrates a non-contrast head CT showing a left parietal hematoma and subarachnoid hemorrhage, which is consistent with bleeding secondary to vitamin K deficiency. Incorrect Answers: Answer 2: Deficiency of factor VIII characterizes hemophilia A, which most commonly presents with hemarthrosis, intramuscular hematoma, and gastrointestinal or genitourinary bleeding. Deficiency of factor VIII causes prolonged PTT with a normal PT. Answer 3: Deficiency of von Willebrand factor is a bleeding disorder that presents with cutaneous and mucosal bleeding and menorrhagia in older patients. Von Willebrand disease also presents with a normal PT. Answer 4: Schistocytes would be consistent with a microangiopathic hemolytic anemia such as hemolytic uremic syndrome (HUS). However, PT and PTT are both normal in HUS. Answer 5: Thrombocytopenia has many possible etiologies in the newborn, including causes of increased platelet destruction (e.g. neonatal alloimmune thrombocytopenia), decreased platelet production (e.g. preeclampsia), and other causes. However, in most of these cases of thrombocytopenia the PT and PTT would be normal. Bullet Summary: Newborns are at high risk of vitamin K deficiency which presents with bruising, gastrointestinal bleeding, and intracranial hemorrhage, and should receive a vitamin K injection as part of their immediate postnatal care.
4.6
(11)
Please Login to add comment