A 4 year old female child presents to the Emergency Department with her foster father.  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 nose 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 reveals a grade 2/6 soft vibratory systolic ejection murmur.  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 11.7 x10⁹/L (Normal range: 6-14 10E9/L)

Hemoglobin 129 g/L (Normal range: 100-150 g/L)

Platelets 6 x 10⁹/L.  (Normal range: 150-400 10E9/L)

INR 1.1  (Normal range: 0.9-1.1)

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