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Investigation for Bleeding Disorders in Suspected Non-Accidental Intracranial Haemorrhage
Petrisse E Seeley1, Paul Monagle1,2, Lydia Garside1
1Sydney Children's Hospital, Randwick, Randwick, New South Wales, Australia.
Journal of Paediatrics and Child Health
|April 22, 2026
Summary
In children with intracranial hemorrhage, inherited bleeding disorders are rare but crucial to identify. Initial screening with a coagulation panel, including activated partial thromboplastin time (APTT), is recommended.
Area of Science:
- Pediatric Hematology
- Child Abuse and Neglect
- Forensic Pathology
Background:
- Abusive head trauma is a leading cause of death in non-accidental injury (NAI) cases among children.
- Intracranial hemorrhage (ICH) in children can rarely stem from inherited bleeding disorders.
- Evaluating ICH in suspected NAI cases requires assessing for bleeding disorders, yet evidence guiding this is limited.
Purpose of the Study:
- To determine the prevalence of inherited bleeding disorders in children with ICH and suspected NAI.
- To identify hematological tests with the highest diagnostic yield in this population.
Main Methods:
- Retrospective cohort study of 120 children with ICH referred to Sydney Children's Hospital (2011-2020).
- Analysis of baseline coagulation screens (Full Blood Count, Prothrombin Time, Activated Partial Thromboplastin Time) performed within 72 hours of presentation.
Main Results:
- Three children (2.5%) were diagnosed with inherited bleeding disorders (hemophilia A, hemophilia B, von Willebrand disease).
- All three identified patients had a prolonged APTT on initial testing.
- Two of the three patients with bleeding disorders were confirmed as NAI.
Conclusions:
- Initial hematological screening for ICH in suspected NAI should focus on FBC, PT/APTT/fibrinogen, unless specific bleeding risk factors are present.
- Abnormal APTT on initial screening is a key indicator for further hematological investigation.
- A consistent approach to hematological evaluation is needed to effectively diagnose inherited bleeding disorders in this vulnerable population.
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