Child Abuse or Bleeding Disorder—An Interdisciplinary Approach

Ralf Knöfler; Werner Streif; Irmina Watzer-Herberth; Gabriele Hahn; Uwe Schmidt

doi:10.1055/s-0039-1677714

Hämostaseologie, Table of Contents

Hamostaseologie 2019; 39(01): 028-035
DOI: 10.1055/s-0039-1677714

Review Article

Georg Thieme Verlag KG Stuttgart · New York

Child Abuse or Bleeding Disorder—An Interdisciplinary Approach

Ralf Knöfler

¹Department of Pediatric Hemostaseology, Medical Faculty Carl Gustav Carus, Technical University Dresden, Children's Hospital, Dresden, Sachsen, Germany

,

Werner Streif

²Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Tirol, Austria

,

Irmina Watzer-Herberth

¹Department of Pediatric Hemostaseology, Medical Faculty Carl Gustav Carus, Technical University Dresden, Children's Hospital, Dresden, Sachsen, Germany

,

Gabriele Hahn

³Department of Pediatric Radiology, Medical Faculty Carl Gustav Carus, Technical University Dresden, Dresden, Sachsen, Germany

,

Uwe Schmidt

⁴Institute of Forensic Medicine, Medical Faculty Carl Gustav Carus, Technical University Dresden, Dresden, Sachsen, Germany

› Author Affiliations

Abstract

Children with an unexplained bleeding tendency are frequently referred to a haemostaseologist for further evaluation. Careful standardized history taking and clinical evaluation should allow for distinguishing bleeds after minor injury and trauma which are very common in all children. However, in two groups of children bleeding symptoms may be more significant than expected: those with an underlying coagulation disorder and those who have been subjected to physical child abuse. The coexistence of child abuse and a bleeding disorder must always be considered. An extended coagulation diagnostic is required if the morphology of bleedings is not clearly suspicious for child abuse and in the absence of typical concomitant injuries, e.g., bone fractures. An interdisciplinary approach involving a forensic pathologist and a paediatric haemostaseologist for assessment of bleeding symptoms, the explanation of the clinical findings, and the critical evaluation of laboratory results are essential in such cases. This review is focussed on symptoms in accidental and nonaccidental injuries in children assisting haemostaseologists in decision making in cases of child protection issues.

Zusammenfassung

Kinder mit unklarer Blutungsneigung werden häufig zum Hämostaseologen zur Abklärung geschickt. Eine standardisierte Ananmneseerhebung und klinische Untersuchung erlauben es zu entscheiden, ob es sich um Blutungen durch kleine Verletzungen und Traumata handelt. In der Regel treten bei 2 Gruppen von Kindern relevante Blutungen auf: Kinder mit Gerinnungsstörung und solche, die körperlich misshandelt werden. Dabei ist stets zu berücksichtigen, dass auch gleichzeitig eine Gerinnungsstörung und eine Misshandlung vorliegen kann. Eine erweiterte Gerinnungsdiagnostik ist erforderlich, wenn die Blutungsmorphe nicht eindeutig für eine Misshandlung spricht und beim Fehlen typischer Begleitverletzungen, wie Frakturen. In diesen Fällen ist ein interdisziplinäres Vorgehen unter Einbeziehung eines Rechtsmediziners und eines pädiatrischen Hämostaseologen zur Beurteilung der Symptome, den Erklärungen für das vorliegende klinische Bild und eine kritische Bewertung der Befunde der Gerinnungsdiagnostik notwendig. Diese Übersichtsarbeit fokussiert auf Symptome bei akzidentellen und nicht-akzidentellen Verletzungen und soll eine Entscheidungshilfe für Hämostaseologen in Kinderschutzfällen darstellen.

Keywords

child abuse - injuries - bleeding symptoms - haemostasis testing

Schlüsselwörter

Kindesmisshandlung - Verletzungen - Blutungssymptome - Gerinnungsdiagnostik

Full Text

References

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