Laposata Martha E, Laposata Michael
Division of Laboratory Medicine, Department of Pathology, Massachusetts General Hospital, Boston, MA 02114, USA.
Am J Clin Pathol. 2005 Jun;123 Suppl:S119-24. doi: 10.1309/H3A67LJ702JQ7YAH.
Child abuse is a problem that is frequently underdiagnosed. Recognition that underdiagnosis of abuse exists has produced a high zeal for identifying cases of child abuse, which has inevitably produced cases of overdiagnosis. Overdiagnosis of child abuse is as catastrophic as underdiagnosis. In this case, a family member is often accused of injuring or killing a child at a time when the loss is felt most deeply. This review focuses on 1 specific presentation of child abuse--the child with bruises and bleeding. Many children and adults have coagulation or vascular disorders that predispose them to bruise or bleed excessively with minor trauma. It is very easy for a health care worker to presume that bruising and bleeding is associated with trauma, because the coagulopathies that may explain the findings are often poorly understood. The clinical cases reviewed in this article show the need for an extremely thorough analysis for an underlying bleeding disorder in the bruised or bleeding child being evaluated as a possible victim of child abuse.
儿童虐待是一个经常被漏诊的问题。认识到虐待存在漏诊情况后，人们对识别儿童虐待病例产生了极大热情，这不可避免地导致了一些过度诊断的情况。儿童虐待的过度诊断与漏诊一样具有灾难性。在这种情况下，往往在一个家庭遭受最深切悲痛之时，有家庭成员被指控伤害或杀害儿童。本综述聚焦于儿童虐待的一种特定表现形式——有瘀伤和出血症状的儿童。许多儿童和成人患有凝血或血管疾病，这使他们在受到轻微创伤时容易出现过度瘀伤或出血。医护人员很容易认定瘀伤和出血与外伤有关，因为可能解释这些症状的凝血障碍往往未被充分了解。本文所回顾的临床病例表明，对于被评估为可能遭受儿童虐待的有瘀伤或出血症状的儿童，有必要对其潜在的出血性疾病进行极其全面的分析。
