Bruises and purpura in children
In a child with recurrent or prolonged bleedings, bleeding at several sites, or bleeding being not in proportion to the local causes, prompt investigations usually in a paediatric hospital are warranted. Blood picture, TT-SPA and activated partial thromboplastin time (APTT) are examined without delay already in the primary care.Petechiae in a febrile child are investigated as soon as possible as a paediatric emergency to diagnose possible meningococcal septicaemia , even if the cause in most cases is a viral infection.Either an acquired or a hereditary disease may explain the bleeding symptoms.Disorders of primary haemostasis (vessel wall defects, e.g Henoch-Schönlein purpura , thrombocytopenias, thrombocytopathies and von Willebrand disease ) are manifested as petechiae in the skin and mucous membranes (nosebleeds, haematuria and melaena). Disorders of secondary haemostasis (haemophilias) are manifested as large, deep bruises or especially intra-articular or intramuscular haemorrhages. Even a minor bleed may continue for days.