title: Bleeding disorders and non-accidental injury.
abstract: Fifty children with suspected non-accidental injury, most of whom had bruising, were investigated to exclude a bleeding disorder. The following investigations were undertaken in each child: full blood count; platelet count, size, and shape; prothrombin time; partial thromboplastin time including mix with normal plasma; fibrinogen; and a bleeding time. The results of these initial investigations were abnormal in eight children (16%). One child had a severe coagulopathy secondary to spontaneously acquired inhibitory activity to coagulation factors which led to spontaneous bruising and noticeable signs of injury after a minor accident. The remaining children had several features supporting a diagnosis of non-accidental injury. Two had associated bleeding disorders in the form of von Willebrand's disease and a platelet aggregation abnormality and a baby had an acquired platelet disorder secondary to salicylates, provoking severe haemorrhage from a minor injury. The remaining four children initially had an abnormal laboratory finding--a prolonged partial thromboplastin time--which resulted in lengthy discussions during subsequent legal proceedings. Evidence of a bleeding disorder is not uncommon in non-accidental injury and the two conditions are not mutually exclusive.
mesh_terms: D001778:Blood Coagulation Disorders / Q000150:complications / Q000175:diagnosis*; D001780:Blood Coagulation Tests; D002648:Child; D002649:Child Abuse; D002675:Child, Preschool; D003937:Diagnosis, Differential; D004438:Ecchymosis / Q000209:etiology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D014947:Wounds and Injuries / Q000150:complications / Q000175:diagnosis*