Ali is a 5 year-old and is brought to the emergency department by his parents with persistent gum bleeding following the loss of a primary tooth. He has had several mild upper respiratory tract infections over the past year, the most recent being 2 weeks ago, otherwise he looks well. On examination he appears well grown, and cardiovascular, respiratory and abdominal examination are unremarkable.

He has multiple bruises over his lower limbs. Bloods are sent and FBC shows:

Hb

13 g/dl

white cell count

12 × 109/l

and platelets

29 × 109/l

Clotting screen

Normal