A former very-low-birth-weight preterm infant with surgically corrected biliary atresia develops a hemolytic anemia at 4 months of age along with edema and thrombocytosis. Peripheral smear shows red cell fragmentation. Which vitamin deficiency is the MOST likely cause?

• A Vitamin K
• B Vitamin B6
• C Vitamin C
• D Vitamin E ✓

Explanation

Vitamin E is a lipid-soluble antioxidant protecting red cell membranes from peroxidation. Deficiency occurs in premature infants and children with chronic cholestasis or fat malabsorption such as biliary atresia, producing a hemolytic anemia, edema, and thrombocytosis. Vitamin K deficiency causes bleeding with prolonged PT, not hemolysis. Diagnosis is confirmed by a low serum vitamin E level relative to total serum lipids.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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