Pediatric Gastrointestinal Bleeding Differential Diagnoses

Updated: Apr 17, 2023
  • Author: Wayne Wolfram, MD, MPH; Chief Editor: Robert K Minkes, MD, PhD, MS  more...
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Diagnostic Considerations

Aside from the disorders listed in the Differentials section, below, other conditions to consider in pediatric patients with symptoms of GI bleeding include the following:

  • NEC

  • Portal hypertension (variceal bleeding)

  • Caustic ingestions

  • Salmonella infection

  • Sexual assault

  • Epistaxis

Apt-Downey test

Maternal blood ingestion is the most common cause of suspected GI bleeding. Blood can be swallowed during delivery or while an infant is breastfeeding (from a fissure in the mother's breast).

If a neonate is actively spitting up or vomiting blood, or if it is significant enough to require placement of a nasogastric tube, one can use the Apt-Downey test to differentiate between maternal and fetal blood.

The blood is placed in a test tube; sterile water is added to hemolyze the RBCs, yielding free hemoglobin.

This solution then is mixed with 1% sodium hydroxide. If the solution turns yellow-brown, the hemoglobin is maternal or adult hemoglobin, which is less stable than fetal hemoglobin.

If the solution remains the same color, it is the more stable fetal hemoglobin; therefore, the newborn is the source of the bleeding.

If the sample is taken from stool that has been exposed to air longer than 30 minutes, even fetal hemoglobin has the yellow-brown color change of adult hemoglobin. In this situation, the quantification of hemoglobin (fetal hemoglobin level >50% points to a source in the child rather than maternal) can be performed with a spectrophotometric assay.

Differential Diagnoses