Otherwise usually extraction should be delayed for at least 10 days after birth because of fear of hemorrhage due to hypoprothrombinemia
. Nowadays delaying of surgical procedure on newborns is no longer considered because of prophylactic administration of vitamin K as a standard procedure in most hospitals .
Since cefmetazole also has the NMTT side chain, it would be expected to produce this effect as well.(54) Cephalosporins with the NMTT side chain have also been associated with hypoprothrombinemia
and bleeding, a point that should be considered in patients receiving anticoagulants.(54)(55)
The following report illustrates a case of trimethoprim/sulfamethoxazole-induced hypoprothrombinemia in a patient receiving ongoing warfarin therapy for atrial fibrillation and aortic valve replacement.
He subsequently experienced significant hypoprothrombinemia with associated bruising following the concomitant use of TMP/SMX therapy for sinusitis.
One of the mechanisms thought to be responsible is sulfonamide impairment of the hepatic metabolism of warfarin.(2)(3) Because long-acting sulfonamides and warfarin are both highly bound to plasma proteins (primarily albumin), another mechanism may be competition between these agents for protein-binding sites, potentially leading to warfarin displacement and elevation of serum warfarin levels, which could enhance the hypoprothrombinemic effect.(4) Several case reports and letters have been published documenting hypoprothrombinemia induced by the concomitant use of warfarin and TMP/SMX,(2)(3)(5)(6)(7)(8)(9) although most predate 1980.
The available literature regarding the onset of the hypoprothrombinemia caused by the warfarin and TMP/SMX interaction varies widely.
The INR should be closely monitored for pronounced hypoprothrombinemia in any patient taking these medications concomitantly.
Differential Diagnosis of Menorrhagia in an Adolescent Anatomic abnormality Genital neoplasm (sarcoma botryoides) Genital trauma or laceration Severe vaginitis (especially streptococcal) Foreign body Prolapsed urethra Bleeding abnormality Platelets Platelet dysfunction Thrombocytopenia Clotting disorder Hemophilia A von Willebrand's disease Afibrinogenemia Hypoprothrombinemia
Dysfibrinogenemia Induced disorder Ingestion of antiplatelet drugs (aspirin) Hormonal abnormality Anovulatory bleeding Pregnancy complication Threatened abortion An appropriate evaluation would include a detailed history and physical examination.