RESUMEN
PURPOSE OF REVIEW: This narrative review aimed to summarize the current evidence on the connection between dysbiosis and vitamin K deficiency in patients with chronic kidney disease (CKD). The presence of dysbiosis (perturbations in the composition of the microbiota) has been described in several non-communicable diseases, including chronic kidney disease, and it has been hypothesized that dysbiosis may cause vitamin K deficiency. Patients with CKD present both vitamin K deficiency and gut dysbiosis; however, the relationship between gut dysbiosis and vitamin K deficiency remains to be addressed. RECENT FINDINGS: Recently, few studies in animals have demonstrated that a dysbiotic environment is associated with low production of vitamin K by the gut microbiota. Vitamin K plays a vital role in blood coagulation as well as in the cardiovascular and bone systems. It serves as a cofactor for γ-glutamyl carboxylases and thus is essential for the post-translational modification and activation of vitamin K-dependent calcification regulators, such as osteocalcin, matrix Gla protein, Gla-rich protein, and proteins C and S. Additionally, vitamin K executes essential antioxidant and anti-inflammatory functions. Dietary intake is the main source of vitamin K; however, it also can be produced by gut microbiota. This review discusses the effects of uremia on the imbalance in gut microbiota, vitamin K-producing bacteria, and vitamin K deficiency in CKD patients, leading to a better understanding and raising hypothesis for future clinical studies.
Asunto(s)
Insuficiencia Renal Crónica , Uremia , Deficiencia de Vitamina K , Animales , Humanos , Disbiosis , Vitamina K/metabolismo , Insuficiencia Renal Crónica/microbiología , Uremia/metabolismo , Uremia/microbiología , Deficiencia de Vitamina K/complicaciones , Deficiencia de Vitamina K/metabolismoRESUMEN
Introducción: Se conoce poco de la forma adquirida del déficit del factor VII y son pocos los casos reportados en la literatura. Objetivo: Presentar el caso de una paciente con déficit aislado del factor VII, en el contexto de una hemorragia digestiva baja. Presentación del caso: Mujer peruana de 82 años que acude a emergencia por presentar hemorragia digestiva baja. Durante los exámenes de rutina se le detecta tiempo de protrombina prolongado y déficit aislado de factor VII. No se evidencia mecanismos patológicos de deficiencia de vitamina K o malabsorción, terapia anticoagulante con antagonistas de la vitamina K, hiperfibrinolisis o coagulación intravascular diseminada. Respondió al tratamiento con plasma fresco congelado y los resultados normales de la prueba hematológica realizada a la hermana, alejan la posible etiología hereditaria. Conclusión: Este caso peruano de déficit aislado del factor VII, en el contexto de una hemorragia digestiva baja, permite sumar información a la escasa evidencia Latinoamericana(AU)
Introduction: Little is known about the acquired form of factor VII deficiency and few cases are reported in the literature. Objective: To present a case of a patient with an isolated deficit of factor VII, in the context of low gastrointestinal bleeding. Presentation of the case: 82-year-old Peruvian woman who comes to the emergency room for presenting with lower GI bleeding. Prolonged prothrombin time and isolated factor VII deficiency are detected during routine examinations. There were no evidence of pathological mechanisms of vitamin K deficiency or malabsorption, anticoagulant therapy with vitamin K antagonists, hyperfibrinolysis, or disseminated intravascular coagulation. She responded to the treatment with fresh frozen plasma and the normal results of the hematological test carried out on the sister remove the possible hereditary etiology. Conclusion: This Peruvian case of isolated factor VII deficit, in the context of low gastrointestinal bleeding, allows adding information to the limited Latin American evidence(AU)
Asunto(s)
Humanos , Femenino , Anciano de 80 o más Años , Deficiencia de Vitamina K , Coagulación Intravascular Diseminada , Pruebas Hematológicas , Servicio de Urgencia en HospitalRESUMEN
This article describes a 19-y-old patient with abdominal pain and signs of malnutrition. She had been treated previously with an antibiotic for chronic diarrhea. Laboratory analyses showed the presence mild hypoalbuminemia, and considerably prolonged prothrombin time. Tests revealed that hemostasis improved after the patient received fresh frozen plasma and vitamin k. A coagulation profile showed a decrease in clotting factors V, VII, IX, and fibrinogen. Positive serology (immunoglobulin A antitissue transglutaminase and immunoglobulin A antiendomysial antibodies) and small bowel mucosal histopathology confirmed the presence of celiac disease (CD). The girl recovered completely after she was put on a gluten-free diet. Vitamin Kdeficiency is a rare complication that occurs in celiac disease manifestations. In addition to antibiotic therapy, treatment with other drugs that influence vitamin K resorption and metabolism may increase the risk of bleeding in patients with CD with hypoprothrombinemia.
Asunto(s)
Humanos , Femenino , Adulto , Trastornos de la Coagulación Sanguínea/complicaciones , Trastornos de la Coagulación Sanguínea/diagnóstico , Enfermedad Celíaca/complicaciones , Enfermedad Celíaca/epidemiología , Deficiencia de Vitamina K/complicaciones , Trastornos de la Coagulación Sanguínea/epidemiología , Síndromes de Malabsorción/diagnósticoRESUMEN
Vitamin K is a key cofactor for the activation of proteins involved in blood coagulation, apoptosis, bone mineralization regulation, and vessel health. Scientific evidence shows an important role of activated osteocalcin and matrix-Gla protein in bone and vessels, markedly affected along the course of chronic kidney disease (CKD). In fact, CKD corresponds to an unique condition of vitamin K deficiency caused by dietary restriction, intestinal dysfunction, and impaired vitamin K recycling. Clinical data suggest that vitamin K status can be modulated and this prompts us to speculate whether patients with CKD might benefit from vitamin K supplementation. However, as important as whether the improvement in vitamin K status would be able to result in better bone quality, less vascular calcification, and lower mortality rates, several issues need to be clarified. These include better standardized methods for measuring vitamin K levels, and definition of the optimal concentration range for supplementation in different subgroups. Here, we review the literature data concerning the impact of vitamin K deficiency and supplementation on CKD-associated mineral and bone disorders (CKD-MBD). We present and discuss the available evidence from basic science and clinical studies, and highlight perspectives for further research.
Asunto(s)
Trastorno Mineral y Óseo Asociado a la Enfermedad Renal Crónica/metabolismo , Deficiencia de Vitamina K/metabolismo , Vitamina K/metabolismo , Trastorno Mineral y Óseo Asociado a la Enfermedad Renal Crónica/tratamiento farmacológico , Humanos , Estructura Molecular , Vitamina K/administración & dosificación , Vitamina K/uso terapéutico , Deficiencia de Vitamina K/tratamiento farmacológicoRESUMEN
Although there are several reports of intracranial hemorrhage associated with vitamin K deficient bleeding, there are few reported cases of extracranial manifestations, specifically involving the thymus. Here, we discuss the unique case of a 4-week-old infant presenting with scrotal discoloration, respiratory distress, and widened mediastinum, found to have thymic hemorrhage related to confirmed coagulopathy secondary to late-onset vitamin K deficiency bleeding of the newborn.
Asunto(s)
Contusiones/etiología , Escroto/patología , Timo/patología , Deficiencia de Vitamina K/complicaciones , Antifibrinolíticos/administración & dosificación , Antifibrinolíticos/uso terapéutico , Contusiones/patología , Diagnóstico Diferencial , Enfermedades de los Genitales Masculinos/etiología , Enfermedades de los Genitales Masculinos/patología , Humanos , Recién Nacido , Masculino , Mediastino/diagnóstico por imagen , Mediastino/patología , Síndrome de Dificultad Respiratoria del Recién Nacido/etiología , Síndrome de Dificultad Respiratoria del Recién Nacido/terapia , Escroto/irrigación sanguínea , Timo/irrigación sanguínea , Resultado del Tratamiento , Vitamina K/administración & dosificación , Vitamina K/uso terapéutico , Deficiencia de Vitamina K/diagnóstico , Deficiencia de Vitamina K/patología , Sangrado por Deficiencia de Vitamina K/tratamiento farmacológicoRESUMEN
Introducción. La deficiencia de vitamina K es prevalente en pacientes con fibrosis quística (FQ) aun con aporte suplementario. Se desconocen factores de riesgo fiables para determinar su ocurrencia. Nuestro objetivo fue evaluar la prevalencia de deficiencia de vitamina K y factores asociados en los pacientes con FQ que no recibían aporte suplementario. Métodos. Se determinaron protrombina inducida por ausencia de vitamina K (PIVKA-II) y osteocalcina infracarboxilada (OCic). Se evaluó el estado clínico y su relación con la deficiencia de vitamina K. El análisis estadístico incluyó prueba de Mann-Whitney, ANOVA o Kruskal-Wallis, prueba χ² o prueba de Fisher-Freeman-Halton y regresión logística múltiple lineal y escalonada hacia adelante. Resultados. Se incluyeron 79 pacientes con FQ de entre 0,4-25,3 años. Se observaron valores anómalos de PIVKA-II y OCic en 56 (70,9%) y 45 (57,0%) pacientes. Los pacientes con PIVKA-II elevada eran significativamente mayores (p = 0,0184) y tenían puntajes Z de peso corporal (p= 0,0297) inferiores a los pacientes que tenían concentraciones normales. No se hallaron diferencias entre los pacientes con OCic normal o patológica. Se notificaron valores anómalos de PIVKA-II y OCic más frecuentemente en pacientes con dos mutaciones graves en el gen CFTR y con un estado nutricional malo/deficiente. Los análisis de regresión múltiple lineal y de regresión múltiple escalonada hacia adelante no revelaron factores predictivos sólidos para determinar la deficiencia de vitamina K. Conclusión. La deficiencia de vitamina K es altamente prevalente durante la evolución natural de la fibrosis quística. No se hallaron determinantes clínicos fiables para precisar su ocurrencia.
Introduction. Vitamin K deficiency is highly prevalent in cystic fibrosis (CF) patients despite supplementation. Moreover, no reliable risk factors for its occurrence are known. The aim was to assess the prevalence of vitamin K deficiency and associated factors in non-supplemented CF patients. Methods. Prothrombin concentration induced by vitamin K absence (PIVKA-II) and the undercarboxylated osteocalcin percentage (u-OC) were determined. In all patients clinical status was assessed and its relation to vitamin K deficiency determined. The following tests were used for statistical analysis: Mann-Whitney test, ANOVA test or the Kruskal Wallis test, the chi-squared test or the Fisher-Freeman-Halton test, and multiple linear and multiple forward stepwise logistic regression analysis. Results. The study group comprised 79 CF patients aged 0.4-25.3 years. PIVKA-II and u-OC were abnormal in 56 (70.9%) and 45 (57.0%) patients. Patients with elevated PIVKA-II were significantly older (p= 0.0184) and had lower Z-score values for body weight (p= 0.0297) than those with normal concentrations. Patients with normal or pathological u-OC percentage did not differ. Abnormal PIVKA-II and u-OC were reported more frequently in subjects with two severe CFTR mutations and with worse/poor nutritional status. Multiple linear and forward stepwise regression analyses did not reveal strong predictive factors of vitamin K deficiency. Conclusion. Vitamin K deficiency is highly prevalent in the natural course of cystic fibrosis. There are no reliable clinical determinants of its occurrence.
Asunto(s)
Humanos , Lactante , Preescolar , Niño , Adolescente , Adulto , Adulto Joven , Deficiencia de Vitamina K/etiología , Deficiencia de Vitamina K/epidemiología , Fibrosis Quística/complicaciones , Prevalencia , Factores de RiesgoRESUMEN
INTRODUCTION: Vitamin K deficiency is highly prevalent in cystic fibrosis (CF) patients despite supplementation. Moreover, no reliable risk factors for its occurrence are known. The aim was to assess the prevalence of vitamin K deficiency and associated factors in non-supplemented CF patients. METHODS: Prothrombin concentration induced by vitamin K absence (PIVKA-II) and the undercarboxylated osteocalcin percentage (u-OC) were determined. In all patients clinical status was assessed and its relation to vitamin K deficiency determined. The following tests were used for statistical analysis: Mann-Whitney test, ANOVA test or the Kruskal Wallis test, the chi-squared test or the Fisher-Freeman-Halton test, and multiple linear and multiple forward stepwise logistic regression analysis. RESULTS: The study group comprised 79 CF patients aged 0.4-25.3 years. PIVKA-II and u-OC were abnormal in 56 (70.9%) and 45 (57.0%) patients. Patients with elevated PIVKA-II were significantly older (p= 0.0184) and had lower Z-score values for body weight (p= 0.0297) than those with normal concentrations. Patients with normal or pathological u-OC percentage did not differ. Abnormal PIVKA-II and u-OC were reported more frequently in subjects with two severe CFTR mutations and with worse/poor nutritional status. Multiple linear and forward stepwise regression analyses did not reveal strong predictive factors of vitamin K deficiency. CONCLUSION: Vitamin K deficiency is highly prevalent in the natural course of cystic fibrosis. There are no reliable clinical determinants of its occurrence.
INTRODUCCIÓN: La deficiencia de vitamina K es prevalente en pacientes con fibrosis quística (FQ) aun con aporte suplementario. Se desconocen factores de riesgo fiables para determinar su ocurrencia. Nuestro objetivo fue evaluar la prevalencia de deficiencia de vitamina K y factores asociados en los pacientes con FQ que no recibían aporte suplementario. MÉTODOS: Se determinaron protrombina inducida por ausencia de vitamina K (PIVKA-II) y osteocalcina infracarboxilada (OCic). Se evaluó el estado clínico y su relación con la deficiencia de vitamina K. El análisis estadístico incluyó prueba de Mann-Whitney, ANOVA o Kruskal-Wallis, prueba χ2 o prueba de Fisher-Freeman-Halton y regresión logística múltiple lineal y escalonada hacia adelante. RESULTADOS: Se incluyeron 79 pacientes con FQ de entre 0,4-25,3 años. Se observaron valores anómalos de PIVKA-II y OCic en 56 (70,9%) y 45 (57,0%) pacientes. Los pacientes con PIVKA-II elevada eran significativamente mayores (p = 0,0184) y tenían puntajes Z de peso corporal (p= 0,0297) inferiores a los pacientes que tenían concentraciones normales. No se hallaron diferencias entre los pacientes con OCic normal o patológica. Se notificaron valores anómalos de PIVKA-II y OCic más frecuentemente en pacientes con dos mutaciones graves en el gen CFTR y con un estado nutricional malo/deficiente. Los análisis de regresión múltiple lineal y de regresión múltiple escalonada hacia adelante no revelaron factores predictivos sólidos para determinar la deficiencia de vitamina K. CONCLUSIÓN: La deficiencia de vitamina K es altamente prevalente durante la evolución natural de la fibrosis quística. No se hallaron determinantes clínicos fiables para precisar su ocurrencia.
Asunto(s)
Fibrosis Quística/complicaciones , Deficiencia de Vitamina K/epidemiología , Deficiencia de Vitamina K/etiología , Adolescente , Adulto , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Prevalencia , Factores de Riesgo , Adulto JovenRESUMEN
As doenças hemorrágicas abrangem diversas condições clínicas, sendo caracterizadas por hemorragias de gravidade variável em diferentes locais do corpo. Podem ser de causa hereditária ou adquirida, relacionadas a doenças hematológicas ou a outras condições sistêmicas. Para o diagnóstico e tratamento adequados dessas doenças éfundamental a realização de anamnese detalhada e de testes laboratoriais, que podem ser complexos. Neste artigo serão abordadas as principais condições hemorrágicas, classificadas em doenças vasculares/doenças plaquetárias, coagulopatias e doenças hemorrágicas secundárias a doenças sistêmicas e uso de anticoagulantes.
The bleeding disorders include several clinical conditions, being characterized by bleeding of varying severity in different body sites. They can be either inherited or acquired disease - related to hematological diseases or other systemic conditions. For the diagnosis and treatment of these diseases, it is essential to conduct a detailed clinical history and laboratory tests, which may be complex. This article deals with the major hemorrhagic conditions, classified as vascular diseases/platelet diseases, coagulopathy and bleeding disorders secondary to systemic diseases and use of anticoagulants.
Asunto(s)
Humanos , Trastornos Hemorrágicos/diagnóstico , Anamnesis , Deficiencia de Vitamina K , Diagnóstico Diferencial , Enfermedades de von Willebrand/diagnóstico , Insuficiencia Hepática , Púrpura Trombocitopénica Idiopática/tratamiento farmacológico , Síndrome Hemolítico-Urémico/diagnósticoAsunto(s)
Humanos , Femenino , Embarazo , Adulto Joven , Complicaciones del Embarazo , Enfermedad Celíaca/complicaciones , Enfermedad Celíaca/diagnóstico , Trombosis/etiología , Hemorragia/etiología , Deficiencia de Vitamina K/tratamiento farmacológico , Deficiencia de Vitamina K/etiología , Diarrea , Aborto EspontáneoAsunto(s)
Humanos , Femenino , Embarazo , Adulto Joven , Enfermedad Celíaca/complicaciones , Enfermedad Celíaca/diagnóstico , Hemorragia/etiología , Complicaciones del Embarazo , Trombosis/etiología , Aborto Espontáneo , Diarrea , Deficiencia de Vitamina K/etiología , Deficiencia de Vitamina K/tratamiento farmacológicoRESUMEN
In Texas, apprentice midwives do not have prescriptive authority to administer parenteral vitamin K. This case report underscores the importance of parenteral vitamin K administration in preventing vitamin K deficiency bleeding and the potential danger in prohibiting apprentice midwives from providing this standard of care to the newborn.
Asunto(s)
Antifibrinolíticos/uso terapéutico , Partería/legislación & jurisprudencia , Deficiencia de Vitamina K/prevención & control , Vitamina K/uso terapéutico , Muerte Encefálica , Humanos , Lactante , Inyecciones Intramusculares , Hemorragias Intracraneales/etiología , Hemorragias Intracraneales/terapia , Masculino , Texas , Deficiencia de Vitamina K/complicacionesRESUMEN
The liver plays a central role in the clotting process. In this organ are sintetizated the major part of the coagulation factors. Historically, was considered that alteration in liver function causes important bleeding disorders. However, actual evidence is not in agreement with this asseveration. Decreased synthesis of clotting and inhibitor factors, decrease clearance of activated factors, quantitative and qualitative platelet defects, hyperfibrinolysis and intravascular coagulation are some of the defects observed in liver diseases. Thrombotic events, even if rare in cirrhotic patients, occur manly in the portal and mesenteric veins. The aim of the present work is to review the present evidence in coagulation disorders and liver disease.
Asunto(s)
Trastornos de la Coagulación Sanguínea/etiología , Cirrosis Hepática/complicaciones , Afibrinogenemia/etiología , Trastornos de la Coagulación Sanguínea/fisiopatología , Factores de Coagulación Sanguínea/biosíntesis , Plaquetas/fisiología , Coagulación Intravascular Diseminada/etiología , Coagulación Intravascular Diseminada/fisiopatología , Fibrinólisis , Trastornos Hemorrágicos/etiología , Trastornos Hemorrágicos/fisiopatología , Humanos , Cirrosis Hepática/fisiopatología , Venas Mesentéricas , Vena Porta , Trombofilia/etiología , Trombofilia/fisiopatología , Trombopoyetina/biosíntesis , Trombopoyetina/deficiencia , Trombosis/etiología , Deficiencia de Vitamina K/etiologíaRESUMEN
The liver plays a central role in the clotting process. In this organ are sintetizated the major part of the coagulation factors. Historically, was considered that alteration in liver function causes important bleeding disorders. However, actual evidence is not in agreement with this asseveration. Decreased synthesis of clotting and inhibitor factors, decrease clearance of activated factors, quantitative and qualitative platelet defects, hyperfibrinolysis and intravascular coagulation are some of the defects observed in liver diseases. Thrombotic events, even if rare in cirrhotic patients, occur manly in the portal and mesenteric veins. The aim of the present work is to review the present evidence in coagulation disorders and liver disease.
El hígado participa de manera importante en el proceso de la coagulación. En él se sintetizan la mayor parte de los factores pro- y anticoagulantes. De manera histórica se ha considerado que las alteraciones en la función de este órgano provoca trastornos predisponentes para eventos de sangrado. La evidencia actual pone en tela de juicio esta aseveración. En los casos de hepatopatía se hacen evidentes alteraciones en el número y funcionamiento de las plaquetas, disminución de la síntesis de factores de la coagulación, disfibrinogenemia, alteraciones en la fibrinólisis, deficiencia de vitamina K y cambios similares a los ocurridos en la coagulación intravascular diseminada (CID). El presente trabajo está dirigido a revisar los conocimientos actuales respecto a las alteraciones de la coagulación presentes en los pacientes con hepatopatías.
Asunto(s)
Humanos , Trastornos de la Coagulación Sanguínea/etiología , Cirrosis Hepática/complicaciones , Afibrinogenemia/etiología , Trastornos de la Coagulación Sanguínea/fisiopatología , Factores de Coagulación Sanguínea/biosíntesis , Plaquetas/fisiología , Coagulación Intravascular Diseminada/etiología , Coagulación Intravascular Diseminada/fisiopatología , Fibrinólisis , Trastornos Hemorrágicos/etiología , Trastornos Hemorrágicos/fisiopatología , Cirrosis Hepática/fisiopatología , Venas Mesentéricas , Vena Porta , Trombofilia/etiología , Trombofilia/fisiopatología , Trombopoyetina/biosíntesis , Trombopoyetina/deficiencia , Trombosis/etiología , Deficiencia de Vitamina K/etiologíaRESUMEN
A necessidade de administração da vitamina K na prevenção da doença hemorrágica do recém-nascido, assim como a via de administração do medicamento, são aspectos controversos. A possibilidade de aparecimento de câncer com o uso da vitaminaK intramuscular tem levado à opção do seu uso por via oral. Por outro lado, essa forma de administração tem aumentado a incidência da doença hemorrágica do recém-nascido em sua forma tardia, que pode surgir até seis meses após a administração, o que levou algunsserviços a manterem a via intramuscular. O local de administração de drogas injetáveis é outro ponto polêmico, pois existe a possibilidade do surgimento de lesão no músculo quadríceps após a aplicação de medicamentos. No intuito de tentar esclarecer algumas dessas dúvidas, foi realizado este trabalho que teve como objetivo acompanhar algumascrianças buscando detectar os possíveis casos de doença hemorrágica do recém-nascido e de danos no músculo quadríceps decorrentes do uso da vitamina K. Foram avaliados, clínica e ultra-sonograficamente, 51 recém-nascidos a termo que receberam l mg (0,1 ml) de vitamina K na face anterolateral da coxa direita nas primeiras horas de vida. Em trêssemanas essas crianças eram reavaliadas. O exame ortopédico constou de inspeção cuidadosa do local de aplicação, mensuração do diâmetro das coxas, medidas das amplitudes dos movimentos das coxofemorais e dos joelhos. A seguir, eles eram encaminhados ao setor de ultrassom e submetidos à verificação da espessura da telasubcutânea e do músculo quadríceps. Decorridos dois anos de seguimento, não foi detectado qualquer caso de doença hemorrágica, câncer ou contratura do músculo quadríceps. A partir da avaliação estatística dos dados obtidos, concluiu-se que a vitamina K na dosagem de 0,1 ml não foi fator de risco estatisticamente significante noaparecimento de lesão nesse músculo.
Asunto(s)
Deficiencia de Vitamina K/prevención & control , Inyecciones Intramusculares/efectos adversos , Muslo , Recién Nacido , Tesis Académica , Contracción MuscularRESUMEN
OBJECTIVE: Patients with cystic fibrosis (CF) and pancreatic insufficiency (PI) commonly have vitamin K deficiency, and those with CF-associated liver disease (CFLD) have universal vitamin K deficiency. We evaluated the effectiveness of an oral fat-soluble vitamin combination (ADEKs) to treat patients with vitamin K deficiency. STUDY DESIGN: Patients with PI and CF (mean age, 15 years; range, 0.6 to 46 years) including 6 with advanced CFLD were prospectively enrolled in a study of a fat-soluble vitamin combination taken on a daily basis. None had received vitamin K supplementation for at least 4 months before the study. Fat-soluble vitamin combination supplementation was given for a minimum of 4 months; the mean vitamin K intake was 0.18 mg/d (SD = 0.1, range, 0 to 0.3). The primary outcome was change in plasma PIVKA-II (prothrombin in vitamin K absence). RESULTS: Before supplementation 58 (81%) of 72 patients had abnormal PIVKA-II levels (>2.9 ng/mL). After supplementation 29 (40%) had abnormal PIVKA-II levels (P =.001). All 6 patients with advanced CFLD had abnormal PIVKA-II levels (median, range of 20.8, 5.5 to 55 ng/mL) before treatment, which corrected to normal in 50% (4.1, 2.1 to 65 ng/mL). Four patients, 2 with CFLD, had a prolonged prothrombin time (>13.5 seconds) at both time periods. CONCLUSIONS: An oral fat-soluble vitamin combination with a modest amount of vitamin K can, as a daily supplement, improve the PIVKA-II levels in patients with PI and CF.
Asunto(s)
Biomarcadores , Fibrosis Quística/complicaciones , Deficiencia de Vitamina K/tratamiento farmacológico , Vitaminas/administración & dosificación , Adolescente , Adulto , Niño , Preescolar , Femenino , Humanos , Lactante , Hepatopatías/complicaciones , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Precursores de Proteínas/sangre , Protrombina , Tiempo de Protrombina , Vitamina K/administración & dosificación , Deficiencia de Vitamina K/complicacionesRESUMEN
BACKGROUND: Neonates on exclusive breast feeding that do not receive vitamin K at birth are at higher risk hemorrhagic disease of the newborn. AIM: To compare the effect of oral or intramuscular administration of vitamin K1 (VK1), on clotting factors II, VII, IX, X and PIVKA II, in children until the 60 days of age with exclusive breast feeding or mixed feeding. PATIENTS AND METHODS: Forty healthy full term infants, distributed in two groups, A: 20 with mixed feeding (formula-feeding and breast-feeding) and B: 20 with exclusive breast feeding, were studied. Nine infants of each group received 1 mg of VK1 intramuscularly and eleven 2 mg VK orally 5 ml of cord blood was collected initially from each infant. Venous blood samples were taken on 15, 30 and 60 days of age. RESULTS: All factors increased in a progressive form reaching levels over 50% at 60 days of age, in both groups. PIVKA II decreased significantly during the study period (p < 0.01). Factor II increased more in children with mixed feeding that received intramuscular vitamin K, than in the rest of study groups. No other differences between groups were observed. No infant had an abnormal bleeding during the study period. CONCLUSIONS: Oral administration of vitamin K is as effective as the intramuscular route in the prevention of the hemorrhagic disease of the newborn.
Asunto(s)
Biomarcadores , Factores de Coagulación Sanguínea/metabolismo , Lactancia Materna , Precursores de Proteínas/metabolismo , Sangrado por Deficiencia de Vitamina K/prevención & control , Vitamina K/administración & dosificación , Administración Oral , Factores de Coagulación Sanguínea/efectos de los fármacos , Factor IX/metabolismo , Factor VII/metabolismo , Factor X/metabolismo , Femenino , Humanos , Lactante , Recién Nacido , Inyecciones Intramusculares , Masculino , Protrombina/metabolismo , Deficiencia de Vitamina K/tratamiento farmacológicoRESUMEN
Objetivo: Chamar a atenção para a forma tardia da doença do recém-nascido secundária à deficiência de vitamina k, como causa de hemorragia intracraniana em lactentes jovens. Métodos: Os autores descrevem e analisam dois casos de doença hemorrágica tardia do recém-nascido, por deficiência de vitamina k, com hemorragia intracraniana no segundo mês de vida. As principais publicações sobre o tema foram revisadas. Resultados: Ambos os lactentes não haviam recebido profilaxia com vitamina k ao nascimento e vinham sendo alimentado exclusivamente com leite materno. Desenvolveram hemorragia intracraniana, e a coagulopatia foi rapidamente corrigida com administração de vitamina k por via intramuscular. Aos 3 e 4 anos de idade, um deles apresenta desenvolvimento psicomotor normal e o outro, atraso psicomotor moderado com microcefalia. Conclusão: A doença hemorrágica do recém-nascido deve ser considerada em lactentes jovens, entre 2 e 12 semanas de vida, com hemorragia intracraniana, sobretudo quando são alimentados exclusivamente com leite materno e não receberam vitamina k ao nascimento. Pode produzir seqüelas neurológicas. A coagulopatia é rapidamente corrigida com vitamina k e é passível de prevenção. Recomenda-se a profilaxia em todo o recém-nascido, logo ao nascimento, com a adminstraçao de 1 mg da viatmaina por via intramuscular