Topic: Paediatric coagulopathies

Options:

A.      Severe haemophilia

B.      Moderate haemophilia

C.      Disseminated intravascular coagulopathy

D.      Von Willebrand disease

E.       Vitamin K deficiency

F.       Liver disease

G.     Protein C deficiency

H.      Physical abuse

Command:

Choose the diagnosis that best fits the presentation.

Scenarios:

1.       A 12 month-old boy is brought to the GP by his foster parents as he has swollen knees.  The GP assesses the boy’s developmental stage during the visit and finds it to be normal as he has just started walking.  However, he has many bruises: this and the symmetry of the joint problems leads the GP to suspect non-accidental injury.

2.       A 13-year-old girl has had easy nose-bleeding since she was a young child and now presents to the GP with very heavy periods.  On questioning of the family history, there are male and female relatives with easy bleeding.

3.       A 6-month old boy suffered from excessive bleeding after his circumcision.  He was premature at birth, then exclusively breast fed.  His mother is on anticonvulsants for her epilepsy.

4.       A neonatal girl with a history of purpura fulminans died of venous thromboembolism.  Her parents were first cousins.

5.       A 5 year old boy developed a high fever, diarrhoea and vomiting after returning from a family safari holiday.  He is now acutely unwell with gangrenous toes, renal failure and bleeding from his nose and venepuncture site.

Answers:

1.       A

2.       D

3.       E

4.       G

5.       C