An Approach to the Bleeding Child

Bleeding in a child can be a diagnostic challenge because of the wide range of possible causes, but making a specific diagnosis is clinically important in order to provide appropriate therapy. An excessive bleeding response to commonly encountered challenges suggests the possibility of an underlying bleeding disorder. Symptoms such as bruising and epistaxis occur frequently in children without underlying bleeding disorders, and so determining which child requires further investigation can be difficult. Even when initial symptoms appear unimpressive, children with underlying bleeding disorders may be at increased risk for significant bleeding associated with surgical procedures or trauma. Bleeding disorders can be inherited or acquired, and include coagulation factor deficiencies, platelet deficiencies and/or dysfunctions, and VWD [1, 2].The evaluation of a child presenting with bleeding should include a comprehensive medical and bleeding history, a complete family history, a detailed physical examination and selected laboratory tests as outlined in algorithm 1.