420 VITAMIN K GROUP 



pected on the basis of melena or hematemesis; although bleeding may occur 

 almost anywhere, areas of predilection are: umbilicus, skin, nose and mouth, 

 intestine, and cerebrum.'*' ^ Ecchymoses and hematomas are usually re- 

 lated to trauma in those receiving too intensive dicoumarol therapy. 



For an extensive study of the gross and microscopic pathology of experi- 

 mental vitamin K bleeding the work of Ferraro and Roizin'' is referred to. 

 They concluded that three factors are important in the causation of bleed- 

 ing: the degree of hypoprothrombinemia, the age of the animal (the 

 younger, the more severe the hemorrhage), and trauma. 



TABLE V 

 Differential Diagnosis of the Bleeding Caused by Vitamin K Deficiency 



" N = normal; Incr. = increased; -t- = positive response; = no response 

 '' Unless there is a coexisting deficiency of vitamin K. 



Although the gross appearance is not in itself diagnostic, the bleeding 

 tendency in vitamin K deficiency differs to some extent from that of scurvy, 

 hemophilia, or thrombocytopenia (Table V). In scurvy there are swollen, 

 spongy, bleeding gums and subperiosteal and intramuscular hemorrhagic 

 extravasations. The hemophiliac tends to bleed in and about joints, with 

 resultant hemarthroses and ankyloses.^ The petechial bleeding of thrombo- 

 cytopenia and scurvy may be confusing, but the platelets are severely 

 depressed only in the former. 



^ L. Salomonsen, Acta paediat. 27, Suppl. 1, 1 (1939). 



5 R. B. Scott, Practitioner 165, 182 (1950) ; B. P. Clark, J. Med. Assoc. State Alabama 

 20, 130 (1950); G. Fanconi, Die Storungen der Blutgerinnung beim Kinde mit 

 besonderer Beriicksichtigung des K-Vitamins und der Neugeborenenpathologie. 

 G. Thieme, Leipzig, 1941. 



6 A. Ferraro and L. Roizin, ^m. J. Pathol. 22, 1109 (1946). 



7 R. K. Ghormley and R. S. Clegg, J. Bone Joint Surg. 30A, 589 (1948). 



