Chapter 92 - Approach to the Pediatric Patient With a Bleeding Disorder

Abstract

Evaluating a child with suspected bleeding disorder is a common yet challenging clinical scenario in pediatric practice. The spectrum of clinical symptoms at presentation could vary from acute bleeding diathesis presenting as hematological emergency to mild bleeding symptoms such as bruising suspicious for child abuse. Therefore, a systematic approach to evaluation of the underlying cause is important. The bleeding disorder could be inherited or acquired and requires careful assessment of primary and secondary hemostasis. Objective quantification of patient's personal history of bleeding along with family history of bleeding provides the basic foundation for subsequent evaluation. The physical exam can provide important clues. Simple bruises over the unexposed parts of the body point toward disorders of primary hemostasis while subcutaneous hematomas and hemarthroses suggest disorders of secondary hemostasis. Similarly, vascular bleeding in setting of benign joint hypermobility syndrome is seen in Ehlers–Danlos syndrome, and bruising in the setting of retinal hemorrhages or old healing fractures result from child abuse. Clinical suspicion needs to be confirmed by laboratory evaluation to reach a diagnosis and initiate appropriate treatment. This chapter outlines the approach to a child with a suspected bleeding disorder, whereas Chapters 117 and 119–122 focus on specific bleeding conditions in the adult population. Key points in history, examination, and investigations are reviewed.