An exclusively breastfed term neonate presents on day 4 of life with oozing from the umbilical stump and cephalhematoma enlargement. PT and aPTT are both prolonged. The underlying defect is:

• A Congenital absence of factor VIII
• B Deficiency of vitamin K dependent factors II, VII, IX and X ✓
• C Immature hepatic synthesis of fibrinogen
• D Consumption coagulopathy from disseminated intravascular coagulation

Explanation

Vitamin K deficiency bleeding of the newborn occurs between days 2 and 7, classically in exclusively breastfed infants who receive little vitamin K from breast milk and whose sterile gut synthesizes none. Factors II, VII, IX and X are vitamin K dependent, prolonging both PT and aPTT. Hemophilia would not present with simultaneous early mucocutaneous and stump bleeding, and DIC shows thrombocytopenia.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.