背景:医疗虐待儿童(MCA)是一种严重的虐待儿童形式。在MCA,看护者夸大地虐待孩子,制造,模拟,或诱发症状,和不必要的,潜在有害的医疗保健会伤害孩子。出血是MCA最常见的表现之一。MCA的诊断具有挑战性,晚期诊断可能会增加严重程度和并发症。一旦怀疑,必须应用所有相关的调查方法来支持和确认诊断,尽快,因为晚期诊断会增加风险。
方法:一名18个月大的男孩因来自不同部位的反复出血事件在2周内被急诊部门转诊至小儿血液科,多次入院。以前,他在不同医院接受了4个月的复发性出血调查.在我们的中心,病史回顾,检查结果,和实验室结果显示一些重要的不一致,导致怀疑MCA和母亲为肇事者。然后他住院接受密切观察。住院期间,母亲报告了多次所谓的出血事件,但任何医院工作人员从未观察到活动性出血.在鼻子或耳朵中没有发现出血灶,支持MCA的诊断。文件被转发到检察官办公室后,孩子被送去机构看护,与母亲分离后没有进一步出血。DNA,这是从住院期间所谓的鼻出血中获得的,被分析并报告属于母亲,确认诊断。
结论:本病例报告通过关注历史和临床体征的不一致以及MCA管理的良好临床实践,提请注意及时诊断。特别强调收集证据,包括DNA样本,确认诊断并帮助法律程序。
BACKGROUND: Medical Child Abuse (MCA) is a severe form of child abuse. In MCA, the caregiver abuses the child by exaggerating, fabricating, simulating, or inducing symptoms, and unnecessary, potentially harmful medical care harms the child. Bleeding is one of the most common manifestations of MCA. Diagnosis of MCA is challenging, and late diagnosis may increase the severity and complications. Once suspected, it is essential to apply all relevant methods of investigation to support and confirm the diagnosis, as soon as possible, as late diagnosis increases the risks.
METHODS: An 18-month-old boy was referred to the Pediatric Hematology by the Department of the Emergency with multiple admissions in a 2-week period for recurrent said-to-be bleeding episodes from different sites. Previously, he had been investigated for recurrent bleeding episodes in different hospitals for 4 months. In our center, the review of medical history, examination findings, and laboratory results showed some important inconsistencies leading to suspicion of MCA and the mother as the perpetrator. Then he was hospitalized for close observation. During hospitalization, multiple episodes of said-to-be bleeding were reported by the mother, but active bleeding was never observed by any hospital staff. No bleeding foci were detected in the nose or ears, supporting the diagnosis of MCA. After the file was forwarded to the prosecutor\'s office, the child was taken for institutional care, and no further bleeding was observed after separation from the mother. DNA, which was obtained from a so-called nosebleed during hospitalization, was analyzed and was reported to belong to the mother, confirming the diagnosis.
CONCLUSIONS: This case report draws attention to timely diagnoses by focusing on inconsistencies in the history and clinical signs and good clinical practices for the management of MCA, with a special emphasis on collecting evidence, including DNA samples, to confirm the diagnosis and help the legal process.