Non-accidental injury and the haematologist: the causes and investigation of easy bruising.

In cases of suspected non-accidental injury in children, it is vital that a haematologist confirms the presence or absence of a haemostatic disorder so that the child welfare and legal systems can make accurate judgements regarding the cause of isolated injuries. The present paper will discuss commonly used methods for the diagnosis of coagulation disorders in children, and will describe how the investigation of easy bruising and bleeding can be highly problematic. For instance, some frequently used tests for the assessment of haemostasis in children are insensitive, inappropriate, or based on values derived from adult populations. Furthermore, artefact is a frequent problem, and many cases present with a negative family history of bleeding. Therefore, the role played by the haematologist in potential child abuse cases is an essential yet challenging one.