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Patterns of bruising in preschool children with inherited bleeding disorders: a longitudinal study
  1. Peter W Collins1,
  2. Melinda Hamilton2,
  3. Frank D Dunstan3,
  4. Sabine Maguire3,
  5. Diane E Nuttall3,
  6. Ri Liesner4,
  7. Angela E Thomas5,
  8. John Hanley6,
  9. Elizabeth Chalmers7,
  10. Victor Blanchette8,9,
  11. Alison M Kemp3
  1. 1Department of Haematology, Institute of Infection and Immunity, School of Medicine Cardiff University, Cardiff, UK
  2. 2Department of Haematology, Ysbyty Gwynedd, Bangor, UK
  3. 3Institute of Primary Care and Public Health, School of Medicine Cardiff University, UK
  4. 4Department of Haematology, Great Ormond Street Hospital, London, UK
  5. 5Department of Haematology, Royal Hospital for Sick Children, Edinburgh, UK
  6. 6Department of Haematology, Royal Victoria Infirmary, Newcastle, UK
  7. 7Department of Haematology, Royal Hospital for Sick Children, Glasgow, UK
  8. 8Department of Paediatrics, University of Toronto, Toronto, Canada
  9. 9Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
  1. Correspondence to Professor Peter W Collins, Department of Haematology, Institute of Infection and Immunity, School of Medicine Cardiff University, Haemophilia Centre, University Hospital of Wales, Heath Park, Cardiff CF14 4XN, UK; collinspw{at}


Objective The extent that inherited bleeding disorders affect; number, size and location of bruises in young children <6 years.

Design Prospective, longitudinal, observational study.

Setting Community.

Patients 105 children with bleeding disorders, were compared with 328 without a bleeding disorder and classified by mobility: premobile (non-rolling/rolling over/sitting), early mobile (crawling/cruising) and walking and by disease severity: severe bleeding disorder factor VIII/IX/XI <1 IU/dL or type 3 von Willebrand disease.

Interventions Number, size and location of bruises recorded in each child weekly for up to 12 weeks.

Outcomes The interventions were compared between children with severe and mild/moderate bleeding disorders and those without bleeding disorders. Multiple collections for individual children were analysed by multilevel modelling.

Results Children with bleeding disorders had more and larger bruises, especially when premobile. Compared with premobile children without a bleeding disorder; the modelled ratio of means (95% CI) for number of bruises/collection was 31.82 (8.39 to 65.42) for severe bleeding disorders and 5.15 (1.23 to 11.17) for mild/moderate, and was 1.81 (1.13 to 2.23) for size of bruises. Children with bleeding disorders rarely had bruises on the ears, neck, cheeks, eyes or genitalia.

Conclusions Children with bleeding disorder have more and larger bruises at all developmental stages. The differences were greatest in premobile children. In this age group for children with unexplained bruising, it is essential that coagulation studies are done early to avoid the erroneous diagnosis of physical abuse when the child actually has a serious bleeding disorder, however a blood test compatible with a mild/moderate bleeding disorder cannot be assumed to be the cause of bruising.

  • Inherited bleeding disorders
  • Bruising
  • Mobility Stage
  • Haemophilia

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