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An apparent case of non-accidental injury
  1. Guan Hao Tan1,
  2. Rajat Bhattacharyya2
  1. 1Department of General Paediatrics, KK Women’s and Children’s Hospital, Singapore
  2. 2Department of Haematology and Oncology, KK Women’s and Children’s Hospital, Singapore
  1. Correspondence to Dr Guan Hao Tan, Department of General Paediatrics, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore; tan.guan.hao{at}kkh.com.sg

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BACKGROUND

A 4-year-old girl of mixed race origin presented with a 1-month history of spontaneous bruising and occasional gum bleeding raising concerns of non-accidental injury (NAI). There was no family history of bleeding tendencies. She was admitted for further investigations.

Examination revealed a thriving girl with multiple bruises over her lower limbs.  (figures 1 and 2). There was no hepatosplenomegaly or lymphadenopathy.

Her initial full blood count is as follows: haemoglobin 12.1 g/dL, total white blood cell count 14.72x109/L (neutrophil 38%, lymphocyte 29%, monocyte 3%, eosinophil 28% and absolute eosinophil count 4.1x109/L). Her platelet count was slightly low at 135x109/L. Prothrombin time (PT) and activated partial thromboplastin time (aPTT) were normal.

QUESTION 1

Apart from investigating for NAI, what features on investigation would distinguish between the differentials below?

  1. Immune thrombocytopenic purpura (ITP).

  2. Congenital platelet disorders.

  3. Acquired platelet dysfunction disorders. …

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