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.

Answers of this discussion
Author :- Pediatric Oncall on 19 May 2013.
Answer :- Vitamin K deficiency must have been cause of hematemesis. Coagulopathy may have got aggravated with sub clinical hepatitis.

Author :- Pramod Kulkarni on 20 May 2013.
Answer :- it fits into late onset vit.k deficiency. transient rise in sgot More than sgpt appears mild-insignificant { Less than 3-4times of basal , n levels}hence non specific and all abnormalities in LFT normalizing over short time excludes ongoing, underlying persistent liver dysfunction.

Author :- HanumanthaRao K.R on 23 May 2013.
Answer :- yes due to vitamin k deficiency. raised liver enzymes may be as part of mild hepatits or benign intrahepstic neonatal cholestasis or familial

Author :- amlcash adv on 25 May 2013.
Answer :- vitamin k diffeiceny

Author :- mona kasemc on 01 June 2013.
Answer :- viral hepatitis

Author :- hesham alic on 02 June 2013.
Answer :- vit k deficiency

Author :- howayda mahmoud on 08 June 2013.
Answer :- yeslate type of hemorrhagic disease

Author :- anupama agarwal on 13 June 2013.
Answer :- vit k deficiency

Author :- K K Verma on 22 June 2013.
Answer :- Late onset hemorrhagic disease

Author :- Mustafa Aydin on 22 June 2013.
Answer :- Late type hemorrhagic disease

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