A 4-day-old exclusively breastfed term male infant born at home presents with oozing from the umbilical stump and blood in stool. Platelet count is 2.4 lakh/mm3, PT is markedly prolonged, aPTT mildly prolonged, fibrinogen normal. What is the most likely diagnosis?
- A Classic vitamin K deficiency bleeding ✓
- B Disseminated intravascular coagulation
- C Hemophilia A
- D Neonatal immune thrombocytopenia
Correct answer: A. Classic vitamin K deficiency bleeding
Explanation
Classical VKDB occurs at 2 to 7 days in breastfed infants who did not receive prophylactic vitamin K at birth. The pattern of isolated prolongation of PT (factor II, VII, IX, X deficient) with normal platelet count and fibrinogen points to vitamin K deficiency. DIC would show thrombocytopenia and low fibrinogen, while hemophilia shows isolated aPTT prolongation with a normal PT.
Reference: Nelson Textbook of Pediatrics, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.