To study the clinicoetiological profile of children admitted with bleeding diathesis

Abstract

 Background: Bleeding complications in children may be caused by disorders of secondary hemostasis or fibrinolysis. A child who presents with bleeding warrants evaluation for a significant bleeding problem. Objectives: The aim is to study the clinicoetiological profile of children admitted with bleeding diathesis. Materials and Methods: Children up to the age of 14 years presenting in the Department of Pediatrics, Pandit B D Sharma Postgraduate Institute of Medical Sciences, Rohtak, with hemorrhagic diathesis, that is, non-traumatic spontaneous bleeding, suspected to be either due to the defective primary hemostatic mechanism (platelet– blood vessel interaction) or defective secondary hemostatic mechanism, were enrolled for this study. Frequency distribution of various bleeding disorders in various age groups was studied. Results: A total of 92 children up to the age of 14 years were taken up for study, of which, maximum cases with bleeding presented with hematemesis (23.9%) followed by melena (22.8%). A total of 73 children (79.34%) presented with skin and joint bleeds. We were able to make diagnosis in 82 children (89.1%). Among 82 patients, 31 (37.8%) had bleeding secondary to infections, 11 (13.4%) had coagulation disorder, 9 (10.97%) had Henoch–
Schonlein purpura (HSP) and immune thrombocytopenic purpura (ITP) each, 6 (7.3%) had hypoplastic bone marrow, 2 (2.4%) had chronic malaria, 4 (4.9%) had leukemia, 6 (7.3%) had liver diseases, and 6 (7.3%) had hemorrhagic disease of newborn (HDN). Almost half of the children with bleeding manifestations in each age group had thrombocytopenia. The most common causes of bleeding in <1 year were septicemia with thrombocytopenia and HDN; among 1-7 years were infections, ITP, and coagulation disorders; and in more than 7 years were HSP, ITP, liver disease, and hemolytic-uremic syndrome. Conclusion: Our study found
that the gastrointestinal tract was the most common site of bleeding in children presenting with non-traumatic spontaneous bleed, and thrombocytopenia was present in 50% of the cases in each age group. We also found that infections were the most common cause of bleeding in younger children, whereas immunological causes and coagulation disorders predominate in older children. Hence, while evaluating any child with bleeding, age at presentation is also an important parameter to find the etiological diagnosis.