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Approach to the child with bleeding symptoms

Donald L Yee, MD
Section Editor
Donald H Mahoney, Jr, MD
Deputy Editor
Carrie Armsby, MD, MPH


Pediatricians will be confronted with an infant, child, or adolescent either with overt bruising or bleeding or with a history of increased bleeding sometime during their busy clinical practice. This topic review will discuss the approach to such patients, including selection of the most appropriate laboratory tests to arrive at a working diagnosis. An approach to the adult with bleeding symptoms and neonatal thrombocytopenia are discussed separately. (See "Approach to the adult patient with a bleeding diathesis" and "Causes of neonatal thrombocytopenia".)


Clinical evaluation of a patient with bleeding symptoms begins with taking a careful history, taking into account the child's age, sex, clinical presentation, past history, and family history.

Bleeding history — In assessing the patient's bleeding history, it is important to ask about prior bleeding episodes and to characterize the type of bleeding (table 1):

Bleeding into the skin and mucous membranes is characteristic of disorders of platelets and blood vessels (purpuric disorders) and may be manifested as petechiae and/or ecchymoses.

Bleeding into soft tissue, muscle, and joints suggests the presence of hemophilia or other disorders of coagulation proteins.

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Literature review current through: Nov 2017. | This topic last updated: Mar 17, 2016.
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