Excluding medical and haematological conditions as a cause of bruising in suspected non-accidental injury.
A mistaken diagnosis of child abuse can occur in a number of medical conditions, many of which can be readily diagnosed by experienced paediatricians. Bleeding disorders offer a greater challenge, especially when court proceedings may demand their exclusion. Some of these disorders are rare but more prevalent in areas which have a high incidence of consanguinity. We advocate two stages of laboratory investigations but the limitations of some of these tests and their inability to exclude a bleeding disorder with absolute certainty should be recognised. However, if personal and family histories are absent and both first-stage and second-stage investigations are normal, it is highly unlikely that a bleeding disorder will be missed.
Minford
A M B
AM
Department of Paediatrics, Bradford Royal Infirmary, Duckworth Lane, Bradford BD9 6RJ, UK. adrian.minford@sky.com
Richards
E M
EM
D019985:Benchmarking; D002648:Child; D002649:Child Abuse / Q000175:diagnosis*; D003288:Contusions / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D005192:Family Health; D006402:Hematologic Diseases / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D010372:Pediatrics / Q000379:methods / Q000592:standards*; D015995:Prevalence; D014947:Wounds and Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology