An approach to investigation of easy bruising

Easy bruising presents several investigative dilemmas in primary and secondary practice, not least because it raises the spectre of physical abuse. When, and to what extent, should general paediatricians investigate before referral to a specialist? When can it be safely concluded that an underlying bleeding disorder has been excluded, so that further investigations can focus on ruling out suspected nonaccidental injury? When, despite an abnormal clotting test, should the latter investigations still be pursued? The intention of this review is to attempt to answer these questions from the perspective of routine practice without recourse to a comprehensive review of bleeding disorders or nonaccidental injury. We intend to address only the patient seen electively in the outpatient clinic for investigation of easy bruising, not an acutely ill child presenting to accident and emergency with purpura, whose diVerential diagnosis varies from, most often, no cause found, to, less commonly, meningococcal sepsis or Henoch– Schonlein purpura.