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Bruises, blood coagulation tests and the battered child syndrome.
[child syndrome]
Cutaneous
bruises
are
a
common
symptom
and
a
sign
of
injury
and
blood
coagulation
disorders
in
childhood
.
A
carefully-taken
history
,
coupled
with
a
thorough
physical
examination
,
would
lead
to
the
diagnosis
,
or
guide
the
clinician
to
the
necessary
laboratory
investigations
.
Most
children
suffering
from
non-accidental
injury
can
have
their
diagnosis
established
on
clinical
grounds
alone
and
do
not
require
laboratory
investigation
.
An
initial
screening
with
full
blood
counts
,
prothrombin
time
and
activated
partial
thromboplastin
time
will
be
adequate
in
most
cases
if
laboratory
investigation
is
indicated
,
but
the
clinician
must
be
aware
of
the
limitations
of
these
tests
.
The
finding
of
an
abnormal
coagulation
test
does
not
exclude
child
abuse
as
it
can
be
a
consequence
of
maltreatment
,
or
the
two
conditions
may
coexist
.
Whenever
necessary
,
the
opinion
of
a
haematologist
should
be
sought
in
order
to
obtain
an
accurate
diagnosis
,
which
is
essential
for
subsequent
management
and
the
prevention
of
further
injury
in
the
case
of
child
abuse
.