Non-accidental injury and the haematologist

Abstract

In cases of suspected non-accidental injury in children, it is vital that a haematologist confirms the presence or absence of a haemostatic disorder so that the child welfare and legal systems can make accurate judgements regarding the cause of isolated injuries. The present paper will discuss commonly used methods for the diagnosis of coagulation disorders in children, and will describe how the investigation of easy bruising and bleeding can be highly problematic. For instance, some frequently used tests for the assessment of haemostasis in children are insensitive, inappropriate, or based on values derived from adult populations. Furthermore, artefact is a frequent problem, and many cases present with a negative family history of bleeding. Therefore, the role played by the haematologist in potential child abuse cases is an essential yet challenging one.

ISTH bleeding assessment tool and platelet function analyzer in children with mild inherited platelet function disorders

“…[11][12][13][14][15][16] Studies in pediatric populations show a similar heterogeneity. [17][18][19][20] The value of the studies investigating PFA to diagnose platelet function disorders in pediatric patients is limited, because most studies do not differentiate between specific IPFD diagnoses.…”

A two-center retrospective review of the hematologic evaluation and laboratory abnormalities in suspected victims of non-accidental injury

“…Despite these associations, neither the frequency of coagulation laboratory abnormalities in the setting of NAI nor the pathophysiology of these changes have been extensively studied. The optimal hematologic evaluation of NAI is not well defined despite expert opinion-based publications (Liesner, Hann, & Khair, 2004; Minford & Richards, 2010; Thomas, 2004). More recently, the American Academy of Pediatrics (AAP) published guideline recommendations for the hematologic evaluation of children with suspected NAI.…”