Abnormal bleeding in children

Abnormal bleeding in children is not uncommon and once again the clinical history, particularly the past and family history, provides the most valuable information. It is important to keep non-accidental injury such as child abuse in mind in the child presenting with 'easy bruising'. However, it is appropriate to exclude a bleeding disorder, especially a platelet disorder.

Coagulation disorders, including haemophilia and von Willebrand's disease, are usually suspected on clinical grounds because of widespread bruising or because of prolonged bleeding following procedures such as circumcision and tonsillectomy.

A common condition is haemorrhagic disease of the newborn, which is a self-limiting disease usually presenting on the second or third day of life because of a deficiency of coagulation factors dependent on vitamin K. The routine use of prophylactic vitamin K in the newborn infant has virtually eliminated this problem.

Idiopathic (immune) thrombocytopenic purpura (ITP) is the commonest of the primary platelet disorders in children. Both acute and chronic forms have an immunological basis. The diagnosis is based on the peripheral blood film and platelet count. The platelet count is commonly below 50 000/ mm3 (50 x 109/L). Spontaneous remission within 4 to 6 weeks occurs with acute ITP in childhood. 2 The commonest vascular defects in childhood are:

• anaphylactoid (Henoch-Schonlein) purpura

• infective states

• nutritional deficiency (usually inadequate dietary vitamin C)

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