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A refugee child with multiple patterned ecchymoses: a diagnostic dilemma between nonaccidental injury and primary

Alexandros Makis1, Vasiliki Masina1, Evangelia-Anna Spiteri1

  • 1Department of Pediatrics, Faculty of Medicine, School of Health Sciences, University of Ioannina.

Blood Coagulation & Fibrinolysis : an International Journal in Haemostasis and Thrombosis
|May 11, 2021
PubMed

Insights

A child

Area of Science:

  • Pediatrics
  • Hematology
  • Medical Diagnostics

Background:

  • A 4-year-old Syrian girl presented with unexplained bruises.
  • The family reported a history of bleeding issues since infancy.

Observation:

  • Bruises were noted in areas typically protected from accidental injury, resembling fingerprints and object shapes.
  • No new bruises appeared during the patient's hospital stay.
  • Initial blood tests for thrombocytopenia and coagulation factor deficiencies were normal.

Findings:

  • Further investigation revealed Glanzmann's thrombasthenia, a rare inherited bleeding disorder.
  • Platelet aggregation tests and flow cytometry confirmed the diagnosis.

Implications:

  • This case highlights the importance of considering rare bleeding disorders in children with unexplained bruising.
  • Healthcare providers must rule out physical abuse while also investigating primary hemostatic defects, as both can coexist.

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