a. Vitamin K deficiency. Vitamin K-dependent factors include II, VII, IX, and X. Malabsorption of vitamin K can follow administration of broad-spectrum antibiotics that alter normal intestinal flora. Deficiency can also follow ingestion of drugs that interfere with vitamin K absorption (ie, cholestyramine, megadoses of vitamin E or A, salicylate overdose). Other causes of vitamin K deficiency include cystic fibrosis, biliary atresia, obstructive jaundice, and short bowel syndrome.

b. Liver disease. Virtually all coagulation factors are synthesized by the liver.

c. DIC. Hemorrhagic disorder associated with activation of procoagulant, anticoagulant, and fibrinolytic mechanisms predisposing host to microvascular hemorrhage as well as thrombosis. Causes include gram-negative sepsis, hypotensive shock, massive trauma, and malignancy.

d. Acquired inhibitory antibodies of hemostasis. Antibodies to coagulation factors, including vWF and factors II, V, and X, may arise spontaneously in a variety of clinical conditions.

Child Abuse. Should be suspected when:

1. Child has an injury with no history of trauma.

2. History is inconsistent with severity of injury.

3. There is a delay in seeking medical care for significant injury.

4. There is a history of poorly explained, recurrent injuries.

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