Diagnostic Dilemma - Pediatric Oncall
Author: Pediatric Oncall
A 4 months old boy born of non consanguineous marriage presented with repeated episodes of hematemesis 25 days ago. The vomit consisted of blood clots and he was admitted in a nursing home where stomach washes were given and which were also blood stained. He was alright within 3 days but again had 2 episodes of hematemesis in last one week. There was no jaundice or bleeding from any other site. There was no malena. He had not received any blood transfusion. On examination, all systems were normal. Investigations showed:
• Hemoglobin = 8.1 gm, dl
• WBC count = 11,800, cumm {13 percent polymorphs, 81 percent lymphocytes}, platelets = 5,90,000, cumm.
• USG Abdomen with colour doppler = Normal
• Bilirubin = 0.8 mg, dl, SGOT = 248 IU, L, SGPT = 123 IU, L, total proteins = 4.9 gm, dl,
albumin = 3.0 gm, dl {SGOT and SGPT also normalized in next one month}
• Prothrombin time = 14.5 sec. {prolonged} and partial thromboplastin time = 41.4 sec. {prolonged} which normalized after Vitamin K injection.
• Meckel’s scan = Normal
• Thrombin time, Platelet function studies = Normal
• OGD scopy = Advised but not done

Child was followed for 1 year and had no further episodes of hematemesis.

Expert Opinion :
Vitamin K deficiency must have been cause of hematemesis. Coagulopathy may have got aggravated with sub clinical hepatitis.
Answer Discussion :
lames osman
viral infection
3 years ago
ajay shastri
the child had vit k dependent coagulation deffeciency which got manifested because of subclinical hepatitis {lateHDN}
3 years ago
raghu reddy
chronic diarrhea _?, viral hepatitis _? can also cause vit k deficiency. factors defiency_?
3 years ago
Mustafa Aydin
Late type hemorrhagic disease
3 years ago
K K Verma
Late onset hemorrhagic disease
3 years ago
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