Blood Disorder and Severe Bruising

[lifelearningrn]

Have any of you ever had a child with a bleeding disorder come to school with constant new bruises to the face, arms, legs, etc.? If so, how did you handle it?

[NRSKarenRN, BSN, RN]

With bruising of the face, along with extremities, child may have Thrombocytopenia ... inquire about platlet count. My nephew developed ITP at age 4. Parents took him to hospital upon my insistence and had to repeatedly educate my SIL about condition.

Quote

Without enough platelets, a child may bleed more easily, including:

• into the skin (bruising)
• from mucosal surfaces (nosebleeds, mouth bleeds, intestinal bleeding, urinary bleeding, and/or excessive menstrual periods)
• sometimes into organs.

http://www.childrenshospital.org/conditions-and-treatments/conditions/t/thrombocytopenia/

Thrombocytopenia:

https://www.nemours.org/content/nemours/wwwv2/services/center-for-cancer-and-blood-disorders/types-of-cancers-and-blood-disorders/thrombocytopenia.html

Kudos to your follow-up for best interest of child to get diagnosis and school action plan.

[LPN Retired, LPN]

I remember when I was in high school a friend of mine frequently came to,school with big bruises all over her legs. Her daddy used to beat her. She was wild though. Wasn't much she wouldn't do. And if he found out about it, the belt came off.

[tining, BSN, RN]

Von Willebrand disease and many other "bleeding disorders." Slight anemia doesn't cover the amount of bruising you are seeing. What does the child say about bruises?

[ruby_jane, BSN, RN]

I appreciate the expert weighing-in about potential causes, because it's valuable. The diagnosis of both VW and thrombocytopenia would have come out (and it's likely the parent would know the name and have researched). I am glad that CPS is already involved. Something is not right.

[SchoolNurseK, BSN, RN]

I agree that something is not right. Parents with chronically ill children are usually more than forthcoming with medical info. I would keep documenting and calling CPS, even if it is multiple times per week. Good for you for digging into this case and not accepting being brushed off. That "feeling" nurses get is usually correct.

[SaltineQueen]

On 1/17/2020 at 11:30 AM, lifelearningrn said:

No, I do not. I've filed 3 reports to CPS, and the guardian is supposed to bring documentation in today. I know that the child has had an open CPS case for a while, and after the third report another case worker came out to see the child. The original case worker (I could hear her yelling at the new one over the phone) says the child has a bleeding disorder that explains why she bruises easily but I've never been provided any documentation.

I'm just wondering if y'all seen any case where severe contusions/bruising that wasn't abuse.

Does CPS have verification from a doctor that he's got a blood disorder or are they just going on what the guardian says?

You'd think a parent of a child with any sort of medical condition that causes bruising would KNOW the name of it and then make sure the school knows about it!

Curious how old the child is. Have you spent time with him and asked him about the bruising? Curious what his response is.

[GdBSN, RN]

Until you receive a medical diagnosis and documentation from a doctor, I would make a CPS call every time you saw a new bruise.

[tining, BSN, RN]

2 hours ago, SaltineQueen said:

You'd think a parent of a child with any sort of medical condition that causes bruising would KNOW the name of it and then make sure the school knows about it!

I have a student that disclosed mild hemophilia. Nothing in system or on annual Health Inventory form. Called mom immediately. Sounded unconcerned that I would need to know.