Seminars in thrombosis and hemostasis
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The historical term "hemorrhagic disease of the newborn," which is used as a synonym for vitamin K deficiency bleeding (VKDB) in infancy, preferably should be abandoned, since neonatal bleeding is often not due to vitamin K (VK) deficiency and VKDB may occur after the neonatal period. VKDB is a form of bleeding that is caused by reduced activity of VK-dependent coagulation factors (II, VII, IX, X), has normal or even increased activity of VK-independent coagulation factors, and responds to VK. Acarboxy proteins are present. ⋯ Repeated (daily or weekly) oral doses of VK are closer to physiologic conditions than single parenteral bolus doses, which expose neonates to excessively high VK levels. The incidence of intracranial VKDB can be reduced if the grave significance of warning signs is recognized (icterus, failure to thrive, feeding problems, minor, bleeding, diseases with cholestasis) or if a simple test for acarboxy proteins (similar to the Guthrie test) would be applicable. Whether or not the more reliable absorption of the new mixed micellar preparation of VK could reduce the protective oral dose of VK prophylaxis has to be evaluated.
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TEG has played an integral part in the growth of liver transplantation. The group at the University of Pittsburgh early on realized that coagulation dysfunction during liver transplantation would be both severe and dynamic. Each phase of the operation appears to have both predictable and unexpected changes in clot dynamics. ⋯ What effect these new medications will have on hemorrhage or thrombosis of vascular anastomoses is yet to be adequately explored. A new awareness appears to be arriving that normal or excessively hypercoagulable states could contribute to such thromboses. TEG as a technology will certainly contribute to a number of future studies and clinical care, which will enhance the conduct of liver transplantation in the future.
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Semin. Thromb. Hemost. · Jan 1995
ReviewAntenatal drugs affecting vitamin K status of the fetus and the newborn.
Coumarin derivatives and anticonvulsants administered during pregnancy enter the fetal circulation, interfering with the action of vitamin K. Vitamin K plays a crucial part in the gamma-carboxylation of glutamic acid residues of the vitamin K-dependent coagulation factors prothrombin, FVII, FIX, and FX. Other vitamin K-dependent proteins in the coagulation cascade are protein C and protein S. ⋯ Transplacental administration of vitamin K has been shown to prevent neonatal hemorrhage induced by maternal anticonvulsant therapy. Prophylactic administration of vitamin K, especially by intramuscular injection, has been reported to be associated with an increased risk of childhood cancer. However, subsequent extensive studies have yielded no evidence of any relationship between prophylactic vitamin K administration and the occurrence of childhood cancer.