Evaluation for Bleeding Disorders in Suspected Child Abuse
James D. Anderst, Shannon L. Carpenter, Thomas C. Abshire, Emily Killough, Consultants, Eneida A. Mendonça, Stephen M. Downs, Cynthia Wetmore, Carl E. Allen, David S. Dickens, James Harper, Zora R. Rogers, Juhi Jain, Anne B. Warwick, Amber M. Yates, Jeffrey D. Hord, Jeffrey H. Lipton, Hope Wilson, staff, Suzanne Kirkwood, Suzanne B. Haney, Andrea G. Asnes, Amy R. Gavril, Rebecca G. Girardet, Nancy Heavilin, Amanda Bird Hoffert Gilmartin, Antoinette L. Laskey, Stephen A. Messner, Bethany Anne Mohr, Shalon Marie Nienow, Norell Rosado, Sheila M. Idzerda, Lori A. Legano, Anish Raj, Andrew Sirotnak, Liaisons, Heather Forkey, Brooks Keeshin, Jennifer L. Matjasko, Heather L. Edward, Section on Pediatric Trainees, staff, Müge Chavdar, American Society of Pediatric Hematology/Oncology Board of Trustees, 2020–2021, Jorge Di Paola, Patrick J. Leavey, Doug Graham, Caroline A. Hastings, Nobuko Hijiya, Jeffrey D. Hord, Dana C. Matthews, Betty S. Pace, María Velez, Dan Wechsler, past board members, Amy L. Billett, Linda C. Stork, staff, Ryan Hooker
Abstract
Bruising or bleeding in a child can raise the concern for child abuse. Assessing whether the findings are the result of trauma and/or whether the child has a bleeding disorder is critical. Many bleeding disorders are rare, and not every child with bruising/bleeding that may raise a concern for abuse requires an evaluation for bleeding disorders. However, in some instances, bleeding disorders can present in a manner similar to child abuse. Bleeding disorders cannot be ruled out solely on the basis of patient and family history, no matter how extensive. The history and clinical evaluation can be used to determine the necessity of an evaluation for a possible bleeding disorder, and prevalence and known clinical presentations of individual bleeding disorders can be used to guide the extent of laboratory testing. This clinical report provides guidance to pediatricians and other clinicians regarding the evaluation for bleeding disorders when child abuse is suspected.