Nirdosh Ashok Kumar
Department of Pediatrics, Aga Khan University Hospital, PakistanFulltext PDF
Factor X is a Vitamin K dependent serine protease that serves as the first enzyme in common pathways of the coagulation cascade. The deficiency of Factor X can be inherited or acquired. Clinically it manifests from mild to severe bleeding and the most common symptoms are epitasis and gum bleeding. Intracranial hemorrhages reported in 9% to 26% of all the patients with Factor X deficiency. Here we present a case of a 3-month-old baby girl who presented in the Emergency Department with fever vomiting and lethargy. During the hospital stay, she developed one episode of generalized tonic-clonic seizures and CT-Scan brain showed huge intracranial bleed with tonsillar herniation. Her coagulation profile showed <6% factor X levels and she was SARS-CoV-2 positive. This is a unique case of a 3-month-old SARS-CoV-2 positive child with spontaneous intracranial bleeding as the first manifestation of Factor X deficiency. No guidelines exist as to how to diagnose such patient early so that prompt intervention could be done to save the patient. We suggest prothrombin time and partial thromboplastin to be included as a routine post-natal investigation to pick this disorder early on. We also suggest the use of cranial ultrasonography in early detection of ICH in patients with signs and symptoms of raised intracranial pressures.
Factor X deficiency; Bleeding disorder; Intracranial Hemorrhage; SARS-CoV-2; Prothrombin time; Partial thromboplastin time; COVID-19; Coronavirus disease 2019
Ashok Kumar N. Spontaneous Intracranial Hemorrhage as the First Manifestation of Severe Factor X Deficiency in 3-Month-Old SARS-CoV-2 Positive Child: A Case Report. Ann Pediatr Res. 2020;4(4):1044..