Distinguishing between Signs of a Bleeding Disorder and Abuse

NHF 2015 (Dallas, August 13-15) There can be difficulties in distinguishing between bruising and intracranial bleeding related to physical abuse or a bleeding disorder. A session at National Hemophilia Foundation (NHF) 2015 Annual Meeting discussed concerns amongst healthcare practitioners (HCP’s) in the bleeding disorder community about the mistreatment of intracranial hemorrhages (ICH). HCP’s speaking at the program suggested that guidelines should be developed to help differentiate bleeding disorders from abuse that take into account the incidence of ICH in children of different ages,  bleeding patterns presentation that would be present in particular bleeding disorders, and also taking other factors (multiple fractures) into account. This will enable the primary care or hospital-based HCP determine if the intracranial hemorrhages are as a result of a bleeding disorder or due to physical abuse. The guideline will take into account other factors that the patient may be experiencing such as multiple fractures which could be suggestive of physical abuse.  The development and use of such guidelines will enable HCPs to more consistently differentiate between symptoms of bleeding disorders and abuse, diagnose bleeding disorders and provide appropriate expert referral to a hematologist for treatment. In parallel, the HCP will be able to identify and report any cases of abuse while having ruled out an underlying bleeding disorder.