Clinical investigations from the RACP

Investigation of the child with easy bruising

Toby Trahair, Richard Cohn, Susan Russell, Glenn Marshall

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Abstract

The presentation of a child with easy bruising can be alarming for both parents and practitioners alike. In many cases, blood counts, blood film and coagulation screening are the appropriate investigations to confirm diagnosis.

Key Points

  • Causes of easy bruising in childhood include platelet disorders (e.g. idiopathic thrombocytopenic purpura) and deficiency of haemostatic factors (e.g. von Willebrand’s disease and the haemophilias).
  • Other causes that do not primarily involve haemostasis, such as nonaccidental injury, malignancy and meningococcal infection, must not be overlooked in the child with easy bruising.
  • A detailed history, including a family history, a physical examination and an understanding of the haemostatic process, provide the basis for clinical diagnosis.
  • Simple tests, including full blood count, blood film and coagulation screen, are usually the most appropriate initial investigations to confirm diagnosis and guide management.

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