Von Willebrand’s Disease Versus Child Abuse

Discerning Von Willebrands Disease Versus Child Abuse

Dr. Michael Laposata MD PhD
Pathologist-in-chief
Vanderbilt University Hospital
Professor of Medicine and Pathology
Vanderbilt University
School of Medicine

The Importance Of Diagnostic Tests

Can a bruised or bleeding child suffer minor unintentional injury and be mistakenly identified as an abused child? Any incorrect conclusion to this question can be catastrophic to the children and parents alike.

The medical literature contains many case reports in which child abuse was overdiagnosed in children with hemorrhagic coagulopathies.  A major concern is overdiagnosis may be more common than is currently believed because of the high prevalence of von Willebrands disease which may be on the order of 1% in the general population.

In 1996, an estimated 3,126,000 child abuse cases were reported to Child Protective Services (CPS) agencies, approximately 31,260 (1%) of which may have a coagulopathy such as vonWillebrand’s disease.

This article goes through the symptoms that suggest child abuse and the noninflicted entities that might cause them. It will take you through a comparison slide show of child abuse versus coagulopathy. What would the findings on a physical examination look like? What are the claims of the parents upon presentation? Is there any relevant history to consider? What hemorrhagic testing should be done?

The article shows the interim actions taken during the investigation and how mistakes can be made. Interpretation of the test results for von Willebrands disease. Safety issues involving clinical laboratories. How easy is it to order the rights tests with reflux testing?

Von Willdebrand Disease contains major types and sub types. There are also many treatment options available.

“At the point the case is reported, the legal and medical
systems merge in an effort to sort out the evidence as fairly
as possible, with maximal “protection” given to the child.
Many issues related to jurisprudence inhibit the sharing of
information, while the medical community optimizes clinical
outcome by information sharing.
The problem becomes apparent in the evaluation of child
abuse when the treating physician is unable to discuss the
case with experts brought by the defense who indeed might
have specialized knowledge not available to the physician
making the diagnosis of child abuse.”

Source:

http://truthinjustice.org/drlaposatacase0730.pdf