Daughter bruising for no reason - abnormal bloods- can anyone help interpret the results please?

[FoxInABox]

My GP is off today so I’m booked in for a call Monday to discuss - can anyone help me to interpret these results and what the next course of action should be? I feel like I’m going to worrying all weekend and I’m also worried the GP didn’t seem concerned when he sent her for the tests so I just want to make sure that she gets the correct further tests or treatment that’s needed.

My teenage DD has been developing large bruises on her legs for no reason, along with small bruising that makes the tops of her thighs look mottled with bruises (best way I can think to describe them). She has lost a bit of weight recently but I put that down to her being on a bit of a health kick. Only other health concerns are she has had stomach pains for around 3 years now which also correlates to when she started her periods. She’s had a few bloods done for that in the past but nothing has flagged up and the doctors have then just said it’s IBS despite no issues with her bowel movements. GP wasn’t particularly worried about the bruising and felt that she must just be knocking her legs on things.

She has just had bloods done which came back with a few abnormal results - low lymphocytes 1.0, as well as abnormal aptt 32.0 and thrombin time 24.6. Aptt ratio was normal. Her prothrombin was within the normal range. Her vitamin D was just below the normal range at 48. Everything else was in the normal range (liver, renal, FBC, thyroid, serum ferritin & iron, hb1Ac - all normal range).

is there any obvious cause for these results? What should the next steps be? I feel like I am going to worrying about this all weekend but the receptionist said she couldn’t get another gp to call as there were no slots left.

I will be so grateful for any help or advice at all.

Yes, that’s what the consultant thought may have started my daughter’s problem.

@Scutterbug - I had a full body rash when I had low Vit D. It was hives but also called Vit D rash. A week of super high supplements cured the rash and then I had to continue taking a high dose for a long time.

Yes! Have they tested her factor viii levels?

Everyone in the uk is deficient in vitamin D over the winter unless we take supplements as there is no goodness from the sun from about October to April. So it’s not that although a D3 supplement would benefit most of us.

Would that have shown in her blood tests though?

Didn't you say her Vit D was below normal at 48? the range in the reports are indicative, individuals need what's the 'right' amount for them to function. It could be that she needs more?
Mine was above normal range but towards the lower end of normal - even that was flagged by my GP and I was prescribed a super high dose for 6-7 weeks.

It's also worse in people with darker skin and can be an issue even in summer particularly in Scotland (less sun)

No GP is doing that,

I have tested this once, needed special authorisation from a haematologist and the lab being ready to process the samples. Plus a haematologist to tell me what the results meant.

Could have written this thread myself but my DD is slightly older. She’s been under the haematologist since November now. They think Von Willibrands or another clotting issue. She’s also being referred for EDS checks as well.
They are unlikely to be quick tbh, and may just order a re test. But if it was urgent they would have called you already. Bloods get screened for urgent issues. My husband once had a call at 10pm to say his blood weren’t good and to come straight in.
Hope you get to bottom of it soon

If she is ready for her menstrual cycle she will mark easier. Us women do. X

My DD had these kind of symptoms starting at puberty around 12 and was eventually (7 years later) diagnosed with mild Hemophilia A when she was 19. Important to know that you have it in case of a hemostatic challenge, but totally treatable.

I had the exact same thing (covered in unexplained bruises) at 21. It took a little while but a platelet check confirmed I had idiopathic thrombocytopenia. My plates were being destroyed by my spleen. Had a splenectomy . Complete cure .

ask family for a platelet count.

Family ? 🙄.. GP …

If there is a clotting issue, does that cause bruises everywhere or can it be localised to arms or legs?

Really! Didn’t know that. Thought clotting factors would be a routine test.

ChatGPT gave me this;

”I understand your concern about these results, but it's important to keep in mind that many factors can affect blood tests, and abnormal results don't always indicate a serious issue. Let’s break down the key points of these results:

1. Low lymphocytes (1.0): Lymphocytes are a type of white blood cell that play a role in immune function. A slight drop in lymphocytes could be caused by various factors, including stress, viral infections, or even just a transient immune response. However, if the count is consistently low or other symptoms are present, it may warrant further investigation.
2. Abnormal APTT (32.0): Activated Partial Thromboplastin Time (APTT) measures the time it takes for blood to clot. A slightly prolonged APTT could suggest a clotting disorder, but since the APTT ratio is normal and prothrombin is normal, it's unlikely to be a major concern. Minor variations in clotting times can also occur due to laboratory differences, and an isolated APTT abnormality doesn't necessarily indicate a serious clotting disorder.
3. Abnormal thrombin time (24.6): Thrombin time measures the conversion of fibrinogen to fibrin in the clotting cascade. An abnormal thrombin time, particularly if isolated, could indicate a fibrinogen issue or a mild clotting abnormality. Given that other clotting tests (like prothrombin) are normal, this may not be something to panic about but may need follow-up if it persists.
4. Vitamin D slightly low (48): While this is below the normal range, it is relatively close to the lower end. Vitamin D deficiency can sometimes contribute to fatigue or muscle weakness. It’s a good idea to consider dietary changes or supplements to bring it back into a healthy range, but it's not necessarily the cause of these abnormalities.

Since most of the other values (liver, renal, thyroid, etc.) are normal, it's reassuring that there are no glaring signs of major organ dysfunction or chronic issues.

Next Steps:

1. Follow-up with your GP: It’s understandable that you're concerned, and it might help to request a follow-up with a GP or ask if there's an opportunity for a phone consultation or to get a second opinion. Sometimes results can be interpreted in a broader clinical context, so it’s best to discuss it with a healthcare provider who can assess the full picture.
2. Repeat testing: Given that some of these abnormalities might be transient (especially lymphocyte counts and minor clotting changes), it could be reasonable to repeat the tests in a few weeks to see if the abnormalities persist.
3. Further investigation for clotting disorders: If the abnormal APTT and thrombin time persist or if there are concerns about clotting, further testing to evaluate clotting factors or conditions like lupus anticoagulant, protein C, protein S, or antithrombin levels could be done.
4. Vitamin D supplementation: If symptoms like fatigue or bone pain are present, addressing the low vitamin D might be worthwhile. Your GP might recommend supplements or dietary changes, but this is unlikely to be the cause of the blood test abnormalities.

Managing the Anxiety: It’s totally normal to feel anxious when dealing with abnormal results. Try to focus on the fact that everything else is normal, and there isn’t a clear cause for immediate concern at this point. You could also make a note of any symptoms she might have had (fatigue, recent infections, etc.) to discuss with the doctor during follow-up. If you're really worried, perhaps consider visiting a walk-in clinic or contacting the GP office for advice on next steps or if there’s a way to get a quick follow-up over the weekend.

Nobody understands clotting except for Haematologists.

The Coagulation Cascade is famously one of the most nightmare things to learn in medical school, every few years they make it worse and and even more bits to it.

It's the kind of thing you learn for the exam and immediately forget.

This is just a slogan, not actual medical advice. And bruising is not a diagnostic symptom of hypermobile EDS.

Exactly why I said “the slogan is…”
bruising can be a symptom of heDS which is different to “just” hypermobility.

Does she have any spots or sores in her mouth? I had very low platelets and had bruising and the little red dots on my legs and round my neck.

@navybean It’s not diagnostic of hEDS whatsoever. It literally isn’t part of the diagnosis. Some people with EDS do bruise easily, yes, because of fragile vascular structures, but EDS is always brought up in random threads because practically any symptom can pop up with it! And very often, as with this, it’s not actually even part of the diagnosis at all.

A slogan isn’t helpful. It’s just words.

Blood Test Results:

1. Low Lymphocytes (1.0 x10⁹/L)

• Slightly low but not dangerously so. Can be caused by: • Recent or chronic viral infections • Stress or fatigue • Autoimmune conditions • Rarely, something more serious like bone marrow issues or blood cancers (e.g. leukemia/lymphoma)—though this is usually accompanied by other abnormal blood markers like white cell count, hemoglobin, and platelets, which you said were normal.

1. APTT (Activated Partial Thromboplastin Time) – 32.0 seconds

• This is slightly prolonged depending on the lab’s reference range. • A prolonged APTT means it’s taking longer than usual for her blood to clot via one of the clotting pathways. Possible causes: • Von Willebrand Disease (most common inherited bleeding disorder) • Lupus anticoagulant (can paradoxically cause clotting or bleeding issues) • Factor deficiencies (e.g. Factor VIII, IX) • Could also be artifact from lab processing or a mild transient abnormality

1. Thrombin Time – 24.6 seconds

• Usually around 14-21 seconds – so 24.6 is prolonged • This measures the final step of blood clotting. • Prolonged TT could point to: • Fibrinogen abnormality • Heparin contamination (rare in normal blood tests) • Liver disease (but you said liver function is normal) • Von Willebrand disease or other clotting factor abnormalities

1. Vitamin D – 48 (just below normal)

• Not typically linked to bruising directly, but low vitamin D can sometimes lead to musculoskeletal symptoms and minor skin fragility. Still, it doesn’t explain the bruising alone.

What Could This Mean?

The key concern here is the unexplained bruising, combined with abnormal coagulation markers, especially in a teenage girl. Some things to raise with your GP:

1. Von Willebrand Disease – This is a very common bleeding disorder and can cause:

• Easy bruising • Heavy periods • Prolonged bleeding • Slightly abnormal clotting times A specific blood test (Von Willebrand factor antigen + activity) is needed to diagnose this.

1. Platelet Function Disorder – Even if platelet count is normal, function might not be. This needs specialist hematology tests.
2. Autoimmune conditions – Things like lupus (SLE) can sometimes present with odd symptoms and bruising, especially in females, and can be tested with ANA and related panels.
3. Leukemia/lymphoma – Very unlikely if all other blood counts are normal (especially WBCs, platelets, hemoglobin), but your GP might still consider repeating FBC in a few weeks and watching for other symptoms (extreme fatigue, infections, swollen glands).

Next Steps You Can Ask for on Monday:
• Referral to pediatric hematology or at least hematology advice
• Von Willebrand factor panel (factor VIII, ristocetin cofactor, antigen levels)
• Clotting factor assays (especially if symptoms worsen or persist)
• Repeat coagulation panel to confirm if the abnormal APTT and thrombin time are consistent
• Consider autoimmune screening (ANA, ENA panel, lupus anticoagulant)
• Urinalysis – to check for microscopic bleeding

In the Meantime:
• Keep a log of any new bruises, where they appear, how big, and any possible triggers
• Watch for any nosebleeds, bleeding gums, heavier periods, or unusual fatigue
• Ensure she avoids high-risk activities (in case of a bleeding disorder)
• You could also write down your full list of concerns to take into the Monday call so nothing gets missed

I recently had bloods and I can back with low WNC and low neutrophils (mild neutropenia)

also my vit D was 49.

I had to have the bloods repeated as they said sometimes WBC can be low due to fighting a virus - even though I didn’t feel ill as such but felt very run down and painful joints.

it came back normal and I’m using vit D spray to up that.

It could be a myriad of things but if they are happy for you to wait a weekend I’d be reassured it’s not a medical emergency swim?

Hope you get some answers or can push for more investigations in the back of this if you feel the tee a something else going on.

Brilliant advice here thank you all so much. I managed not to worry about it last night and feel much better having some questions to hand for the appointment now.

I don’t think there are any further symptoms but the bruising is extensive on her legs which is what had me worried enough to go the doctors. She does sometimes look paler than normal, I’ve felt her glands in her neck and one feels enlarged but the other side doesn’t. I wouldn’t say it’s huge though. She is otherwise fit and well and hasn’t had any virus or cold in a long time - I can’t actually remember the last illness she had. She has lost weight recently but I feel that can be explained as she is eating healthier and training for trials for her sport. She did get a telling off at her last brace appointment as her gums were inflamed and bleeding a little- she’s normally very good with her dental hygiene so I’m wondering now if that is linked. She has also had the odd migraine that has caused her double vision, and can get dizzy in first standing - those have been issues over the last couple of years though.

Her platelet count was normal at 179 but has dropped from 208 last April and previous readings were as high as 349- I don’t know if this lowering over time is an issue? Though it is over quite a prolonged time so I’m guessing that’s okay.

She isn’t taking any medication - apart from Levocetirizine as needed. She has chronic spontaneous urticaria (also reacts to low temperature)& dermatographia, and she’s currently waiting on skin tests for allergic reactions she’s been having to make up. Only other health issues have been the ongoing stomach pain problem since her periods started, and that her periods are erratic and can be heavy - she once had just a week between periods for example.

Apologies that this is a bit of an essay and I haven’t tagged anyone but I have tried to answer everyone, also sorry if I have missed anything. I really appreciate all of the advice and I am making notes for the appointment .

We’re all entitled to post on threads and share input so I really don’t understand why you keep trying to tell me off?!. I didn’t say it was part of the diagnostic criteria. And the slogan is very helpful for someone who for years gets sent to different specialists because the symptoms / signs/ presentations are all so variable. It might be words to you but a diagnosis can be life changing for others. So with all respect, you need to chill out and stop trying to correct me. All I asked another poster was if she was aware of EDS. Anyway, have a good day!