108
98
23
36.9
96/70

A 4 year old female child presents to the Emergency Department with her foster mother.  The child had a recent upper respiratory tract infection 16 days ago and now has a 2 day history of bruising. The child has not had gum bleeding. There is no past history of bleeding nor bruising. 

On exam, the child looks well, actively running around the room.  Vitals as listed. 

Head and neck exams are normal.  There are no adventitious breath sounds.  Cardiac exam is normal.  The skin exam shows 1 mm diameter, non-blanching, red spots scattered diffusely and small bruises over the arms and legs.  There is no adenopathy, no hepatosplenomegaly and all joints are normal. 

Lab work 

CBC -  WBC 9.2 x109/L (Normal range: 6-14 10E9/L)

Hemoglobin 126 g/L (Normal range: 100-150 g/L)

Platelets 7 x 109/L.  (Normal range: 150-400 10E9/L)

INR 1.2  (Normal range: 0.9-1.1)

PTT 34 seconds. (Normal range: 27.0-37.0 seconds)

What is(are) the most important initial investigation(s)?

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Authors

Dr. Susan Bannister

Susan.Bannister@ahs.ca

Dr. Marc Zucker

Zucker@cheo.on.ca

Reviewer

Dr. Karen Forbes