{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T16:18:19Z","timestamp":1782922699320,"version":"3.54.5"},"reference-count":29,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2024,8,8]],"date-time":"2024-08-08T00:00:00Z","timestamp":1723075200000},"content-version":"unspecified","delay-in-days":7,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2024,7,26]]},"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:p>Vitamin K is an essential dietary cofactor required for the synthesis of active forms of vitamin K-dependent procoagulant proteins. Vitamin K deficiency, particularly late-onset deficiency occurring between 1\u2009week and 6 months of age, can cause a life-threatening bleeding disorder. An exclusively breastfed, full-term, 6-week-old infant male presented with severe haemorrhagic shock and multi-system organ failure related to caregiver refusal of intramuscular vitamin K after birth. Coagulation studies were normalised within 8\u2009hours of intramuscular vitamin K administration. An increasing number of caregivers are refusing intramuscular vitamin K which has led to a rise in the incidence of vitamin K deficiency bleeding. Health policy organisations around the world emphasise the benefits of intramuscular vitamin K and risks of refusal, particularly in exclusively breastfed infants who are at higher risk due to low vitamin K levels in breast milk. This case highlights the multi-system severity of this life-threatening yet preventable disorder.<\/jats:p>","DOI":"10.1136\/bcr-2024-261126","type":"journal-article","created":{"date-parts":[[2024,8,9]],"date-time":"2024-08-09T00:36:31Z","timestamp":1723163791000},"page":"e261126","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Late-onset vitamin K deficiency presenting as haemorrhagic shock and severe multi-system organ failure"],"prefix":"10.1136","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2209-9817","authenticated-orcid":false,"given":"Justin M","family":"Azar","sequence":"first","affiliation":[{"name":"Janet Weis Children's Hospital, Danville, Pennsylvania, USA"},{"name":"Pediatrics, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Lambert","sequence":"additional","affiliation":[{"name":"Janet Weis Children's Hospital, Danville, Pennsylvania, USA"},{"name":"Pediatrics, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank Anthony","family":"Maffei","sequence":"additional","affiliation":[{"name":"Janet Weis Children's Hospital, Danville, Pennsylvania, USA"},{"name":"Pediatrics, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tessy A","family":"Thomas","sequence":"additional","affiliation":[{"name":"Janet Weis Children's Hospital, Danville, Pennsylvania, USA"},{"name":"Pediatrics, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,8,8]]},"reference":[{"key":"2025082710364773000_17.8.e261126.1","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1093\/nutrit\/nuab061","article-title":"Vitamin K - 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