Intracranial haemorrhage in two infant siblings: hereditary or acquired?

Objective Non traumatic intracranial haemorrhage (ICH) is uncommon. Common etiology includes vascular diseases and blood dyscrasias. ICH in infant need a trial of Vitamin K injection for a reversible entity of Vitamin K Deficiency Bleeding (VKDB). We report two subsequently born infants to a consanguineous couple with spontaneous ICH which was unique in terms of recurrence of VKDB in a family. Methods A 2-month-old female infant presented with vomiting and focal seizure followed by left hemiparesis and admitted with worsening encephalopathy. Baby was born vaginally at village health facility. There was no h/o bleeding from other sites. Neuroimaging revealed ICH without mass effect. Investigations revealed Anemia however liver, renal function and coagulation profile were normal. The infant was managed with Vit K Injection, component support, oxygen, IV antibiotics and Antiseizure medications. Infant underwent genetic evaluation keeping a possibility of a rare inherited haematological disorder owing to consanguinity and previous sibling death . Results Protein Induced by Vit K Absence II (PIVKA II) biomarker of VKDB was about 20 times elevated. The genetic testing came negative and hence a diagnosis of late onset VKDB confirmed. On follow up child is gaining milestones with residual left hemiparesis. Conclusion Non traumatic ICH in infancy should arise suspicion of VKDB and must be empirically treated with Vitamin K awaiting investigations as a life saving measure. Hence it is prudent to administer Vitamin K to all newborns upto 6 months of age as prophylaxis by deliberate history taking if missed erroneously at birth.
Keywords: 
- Protein Induced VitK Absence , Vitamin K Deficiency Bleeding