title: Bleeding as presenting symptom of cholestasis.
abstract: Four infants with conjugated hyperbilirubinemia who were brought for treatment primarily because of a hemorrhage are reported. Underlying disorders included extrahepatic biliary atresia, choledochal cysts, and alpha 1-antitrypsin deficiency. Prodromal signs of disturbed coagulation and diminished bile excretion were not recognized. The increased bleeding tendency was probably caused by vitamin K deficiency, resulting from a combination of cholestasis-induced fat malabsorption, absence of vitamin K supplementation after birth, and low vitamin K intake as a result of breast feeding.
authors.affiliation: Department of Pediatrics, Erasmus University, Rotterdam, The Netherlands.
authors.forename: J N
authors.initials: JN
authors.lastname: van den Anker
authors.forename: M
authors.initials: M
authors.lastname: Sinaasappel
mesh_terms: D001656:Biliary Atresia / Q000150:complications*; D002543:Cerebral Hemorrhage / Q000209:etiology*; D015529:Choledochal Cyst / Q000150:complications*; D005260:Female; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007567:Jaundice, Neonatal / Q000209:etiology*; D008297:Male; D014813:Vitamin K Deficiency / Q000150:complications; D019896:alpha 1-Antitrypsin Deficiency