CASE REPORTSA refugee child with multiple patterned ecchymoses: a diagnostic dilemma between nonaccidental injury and primary hemostatic defectMakis, Alexandrosa; Masina, Vasilikia; Spiteri, Evangelia-Annaa; Aggeli, Ioannaa; Vartholomatos, Georgiosb; Chaliasos, Nikolaosa; Pergantou, HelencAuthor Information aDepartment of Pediatrics, Faculty of Medicine, School of Health Sciences, University of Ioannina bMolecular Biology Laboratory, Ioannina University Hospital, Ioannina cHaemophilia Centre- Haemostasis and Thrombosis Unit, ‘Aghia Sophia’ Children's Hospital, Athens, Greece Correspondence to Alexandros Makis, Associate Professor in Pediatrics/Pediatric Hematology, Department of Pediatrics, Faculty of Medicine, School of Health Sciences, University of Ioannina, PO Box 1187, GR-45110 Ioannina, Greece Tel: +30 2651099598111; fax: +30 2651007038; e-mail: [email protected] Received 15 March, 2021 Revised 26 March, 2021 Accepted 21 April, 2021 Blood Coagulation & Fibrinolysis: December 2021 - Volume 32 - Issue 8 - p 603-606 doi: 10.1097/MBC.0000000000001047 Buy Metrics Abstract A 4-year-old girl from Syria presented to the hospital with multiple bruises on her body. Bruises were observed in protected areas in a shape of fingerprints and objects, while no other bruises occurred during hospitalization. The parents also reported a history of bleeding diathesis from infancy. Both the initial laboratory evaluation and the secondary tests done for possible thrombocytopenia and coagulation factors deficiencies were normal. Thus, the nonaccidental injury protocol of the Hospital was activated, and the possibility of abuse was not quite evident. Investigation for platelet disorders followed. Platelet aggregation test and flow cytometry were indicative of Glanzmann's thrombasthenia. It is of great importance in these cases, that the doctor eliminates any possibility of physical abuse and examines the patient for common and rare primary hemostatic defects, although both can co-exist. Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.