Valid crying and age-appropriate neurological findings

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Reference no: EM133851825

Case presentation

We reported the case of a 2 months and 20 days white Caucasian male, presented for bleeding from the injections sites of the first dose of hexavalent and pneumococcal vaccine.

He was born from unrelated parents at 41 weeks of gestational age by urgent cesarean section, with a birth weight of 3200 kg and a 5-min Apgar score of 10. His mother reported no use of drug during pregnancy and a previous miscarriage. At birth oral vitamin K prophylaxis was administered. Neonatal period was normal. He was exclusively breastfed and he received a daily supplementation of 25 μg of vitamin K and 400 IU of vitamin D.

At admission he was in fairly good general conditions, he was awake and responsive, with a valid crying and age-appropriate neurological findings. On the anterior region of both thighs, the injection sites of vaccines were recognizable, with a slight bleeding from the injection site on the left leg, without signs of edema. He had a normal cardiorespiratory activity and normal vital signs (blood pressure 70/46 mmHg, heart rate 126 bpm, respiratory rate 30 cpm/min, body temperature 36 °C).

Diagnostics

Blood tests showed a progressive anemia with a minimum value of hemoglobin of 7.8 g/dl

Treatment and Management

Based on the clinical history and laboratory findings, a vitamin K deficiency bleeding "late onset" was suspected. Intravenous Vitamin K (Konakion 10 mg) was administered together with a continuous infusion of 1 g of tranexamic acid. Considering the low hemoglobin values, he was transfused without any adverse reaction.

After vitamin K administration a normalization of the coagulation parameters with persistence of anemia (Hb 8.8 g/dl) was observed. Treatment was therefore continued with oral vitamin K, and iron and folic acid supplementation.

During hospitalization, he did not presented further bleeding or other symptom. At discharge coagulation parameters were normal (PT 12.4 s, INR 0.94, aPTTs 28.5 s, aPTT-r 0.98, PLT 328,000/μl, fibrinogen 414 mg/dl) and hemoglobin values were increased (Hb 9.8 g/dl). The child was discharged with the indication to continue oral vitamin K supplementation with Konakion 10 mg twice weekly until weaning.

Reference no: EM133851825

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