Patterns of bruising in preschool children with inherited bleeding disorders: a longitudinal study

Abstract

ObjectiveThe extent that inherited bleeding disorders affect; number, size and location of bruises in young children <6 years.DesignProspective, longitudinal, observational study.SettingCommunity.Patients105 children with bleeding disorders, were compared with 328 without a bleeding disorder and classified by mobility: premobile (non-rolling/rolling over/sitting), early mobile (crawling/cruising) and walking and by disease severity: severe bleeding disorder factor VIII/IX/XI <1 IU/dL or type 3 von Willebrand disease.InterventionsNumber, size and location of bruises recorded in each child weekly for up to 12 weeks.OutcomesThe interventions were compared between children with severe and mild/moderate bleeding disorders and those without bleeding disorders. Multiple collections for individual children were analysed by multilevel modelling.ResultsChildren with bleeding disorders had more and larger bruises, especially when premobile. Compared with premobile children without a bleeding disorder; the modelled ratio of means (95% CI) for number of bruises/collection was 31.82 (8.39 to 65.42) for severe bleeding disorders and 5.15 (1.23 to 11.17) for mild/moderate, and was 1.81 (1.13 to 2.23) for size of bruises. Children with bleeding disorders rarely had bruises on the ears, neck, cheeks, eyes or genitalia.ConclusionsChildren with bleeding disorder have more and larger bruises at all developmental stages. The differences were greatest in premobile children. In this age group for children with unexplained bruising, it is essential that coagulation studies are done early to avoid the erroneous diagnosis of physical abuse when the child actually has a serious bleeding disorder, however a blood test compatible with a mild/moderate bleeding disorder cannot be assumed to be the cause of bruising.

Characteristics, complications, and sites of bleeding among infants and toddlers less than 2 years of age with VWD

“…These findings were consistent with those in other studies that have attempted to describe patterns of bleeding and bruising among children and have found that bleeding, especially in infants, may be indicative of either abuse/trauma or the presence of a severe bleeding disorder. 10,25,26 Although the other studies did not specifically address the age range of our cohort, findings of earlier and increased bleeding events among patients with more severe forms of VWD were consistent.…”

“…The low rate of treatment with desmopressin (14%) is not surprising, given that, in very young patients, desmopressin is contraindicated because of the higher risk of hyponatremia and seizures in this age group. 26,31 The UDC project ended in 2013, and we would expect to see even lower rates of use of desmopressin in the present-day management of ITs with VWD, given the safety concerns. Our data source does not enable us to examine whether desmopressin was given intranasally or IV, or administered while the patients were in the hospital with laboratory sodium monitoring.…”

Multiple Abusive Fractures in an Infant With a Concurrent Parathyroid Hormone–Related Peptide–Secreting Renal Tumor

“…Although premobile infants with legitimate bleeding disorders have more and larger bruises than those without bruises, their bruise distributions are similar to normal infants. 12 After mobility, lower leg bruises become more common, but this premobile child's leg bruise was lateral, overlying his fracture. A 5-to 6-month-old would not generate sufficient energy by rolling into an object to cause his earlier temple bruising.…”

Sports and Children with Hemophilia: Current Trends

“…To prevent joint and muscle bleeding, parents put their children with hemophilia through various exercise programs [5]. Muscle atrophy, instability and restriction of motion are the first visible signs of sedentarism [6], whereas early subclinical symptoms such as tender ligaments are found even in clinically healthy young people [1].…”