In certain genetic disorders like Von Willebrand Disease, the child may have bruising and increased nose bleeds, or girls may have heavy menstrual bleeding.
When the child starts learning to crawl, stand up and walk, they get prone to bruising. Most parents visit the doctor and are anxious that bruising is a sign of serious illness requiring intervention; however, most of the time, it is benign. Normal bruising is benign and doesn’t merit a detailed workup. These commonly occur on shins and are flat and small, the size of a rupee coin. Dr Rohit Kapoor, Consultant Pediatric Hematologist, Max SuperSpeciality Hospital, Vaishali, Ghaziabad, UP,explains how sometimes kids can develop abnormal bruising.
Bruise Evolution
The general evolution of a bruise is that it starts with a red spot and evolutes in a day or so into a blue colour lesion, which appears as a bruise. Then, it gradually changes to a green, purple or sometimes yellow-brown hue before it fades completely. However, suppose there is any deviation from the usual pattern and persistence of a bruise that keeps progressing and doesn’t show signs of normal evolution. In that case, such a bruise merits an evaluation.
Role Of Pediatric Haematologist
Any abnormal bruising should be evaluated by a pediatric haematologist, such as the unusual formation of a large bruise, even with a trivial trauma or bruising without any history of trauma and an injury lasting longer than usual. Bruising that requires exceptional merit are those in which there is a family history of easy bruising, bleeding or history of easy bruising that occurs in maternal uncles, which may require workup for haemophilia. Further easy bruising also requires a workup for disorders like von Willebrand disease.
Bruising Evaluation
If the child has bleeding lasting longer than usual during any dental procedure or surgery or has a history of nose bleeding that lasts longer than 10 mins and does not abort even if regular supportive measures are taken, it requires a workup. Also, bruising that occurs before the infant starts walking or at unusual sites like hands, ears, chest, or buttocks requires an evaluation.
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Causes Of Bruising
There can be various causes of bruising, and sinister causes like child abuse, and bleeding disorders must be examined in history and clinical examination. In addition, the intake of aspirin, antibiotics or specific antiseizure medication can lead to bruising. A doctor will order the basic set of investigations is the complete blood count and a smear of the blood to look for abnormal cells and platelet morphology. Then, the doctor will order a bleeding test, which can be prolonged in factor deficiency that can be a clue to the diagnosis.
Immune Thrombocytopenia
Significant pathological bruising can be due to causes like Hemophilia A, Vitamin K deficiency or immune thrombocytopenia. Thus, it is imperative to rule out the inherited causes of bleeding like haemophilia, in which the child may have joint swelling and bruising when it starts to crawl, walk or stand up and run. A history of similar bruising in maternal uncles may explain the diagnosis. In immune thrombocytopenia, the child is non-sick-looking and alert but has evidence of bruising. A child with bleeding and suspected cancer may have swelling of the lymph nodes, bone pains, and sometimes bleeding and usually looks sick. In certain genetic disorders like Von Willebrand Disease, the child may have bruising and increased nose bleeds, or girls may have heavy menstrual bleeding.
To Conclude
If the kid has bruising, most frequently, it may be related to his frequent bumping and most of the time, and the parents don’t have to worry. However, suppose there is extensive bruising or bruising due to trivial trauma or joint swelling, frequent nose bleeds, or excessive menses. In that case, the doctor will order some tests to determine whether it needs treatment or needs to be conservatively managed.
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