Evaluation of Easy Bruising in Children

Initial Assessment and History

A detailed bleeding history should be obtained, including questions about significant bleeding after surgery, dental procedures, or minor trauma, to distinguish between benign causes and bleeding disorders 1, 2
Documenting medication exposure, including prescription medications, NSAIDs, anticoagulants, antiplatelets, and corticosteroids, is crucial as these can affect bleeding tendency and coagulation test results 1, 2
Assessing family history of specific bleeding disorders in relatives and ethnicity associated with higher rates of certain bleeding disorders can help identify potential underlying conditions 1, 2

Initial laboratory screening should include a complete blood count (CBC) with platelet count, peripheral blood smear, prothrombin time (PT), activated partial thromboplastin time (aPTT), and fibrinogen level if PT or aPTT are abnormal 1, 2
Recognize that PT and aPTT do not reliably detect von Willebrand disease, factor XIII deficiency, or platelet function disorders, and additional testing may be necessary if clinical suspicion remains high 1, 3

For a 6-year-old with bruising, a skeletal survey is not routinely indicated unless the bruising pattern is concerning or there are additional injuries suggestive of abuse, in which case child protective services evaluation is warranted 4, 1
Avoid extensive testing without clinical indication, as the extreme rarity of some bleeding disorders makes universal screening unreasonable, and observation may be appropriate for typical bruising locations in an active child with no bleeding symptoms or concerning history 1

Refer to pediatric hematology when initial laboratory evaluation indicates a bleeding disorder, high clinical suspicion remains despite normal laboratory workup, specialized testing is needed, or complex cases require expert interpretation 1, 2, 3
Do not assume normal platelet count excludes all platelet disorders, as qualitative platelet defects require specialized testing, and do not overlook medication effects or vitamin K deficiency 3, 2, 1