Bruising and spontaneous bleeding
| Don't forget non-accidental injury | |
|---|---|
| History | - Anaemia: fatigue, SOB, headache, angina - Leukopenia: -- Neutropenia → bacterial or fungal infections in skin, mouth, throat and chest -- Lymphopenia → reduced B or T cell immunity → viral infections, TB, protozoal and fungal infections - Thrombocytopenia: -- mucosal bleeds e.g. nose bleeds, menorrhagia; bleeding after trauma e.g. surgery -- Ask about bruises/rash: ecchymoses, purpuric rash, petechiae (bleeding under skin) - Diet, PMH, previous transfusions, other connective tissue disorders - DHx: antiplatelets, anticoagulants, steroids |
| Examination | Distribution of bruising - always thinking about non-accidental injury ('ten-4 faces') |
| Diagnostic investigations | FBC → which cell lines are affected? Clotting, LFT (The sick liver patient?) Renal function |
| Differentials | |
| Immediate management | Bleeding in haemophilia → direct pressure, TXA, DDAVP (minor bleeding, age >2), factor replacement |
| Ongoing management | Non-accidental injury? |