When to suspect a bleeding disorder:
(1) family history of a bleeding disorder
(2) petechiae or bruising at pressure points
(3) generalized petechiae or bruising
(4) bruising or petechiae that cannot be explained by abuse or trauma
When to suspect abuse:
(1) abuse disclosed or independently witnessed (a verbal child should be interviewed away from parent or guardian)
(2) bruising or injury that has a hand or object pattern
(3) other medical findings consistent with abuse (burns, internal abdominal trauma, fractures, etc)
(4) intracranial bleeding in a nonmobile child in the absence of documented trauma
When to suspect nonabusive trauma:
(1) disclosed or independently witnessed
(2) bruising or injury in a location unusual for abusive injury
Screening tests for a bleeding disorder:
(1) prothrombin time
(2) activated partial thromboplastin time
(3) platelet count
(4) history of medications especially aspirin
Additional tests to use in selected individuals:
(1) plasma fibrinogen
(2) d-dimer or fibrin degradation products (FDP)
(3) Factor VIII
(4) Factor IX
(5) von Willebrand panel
