The presence of petecchial spots without hemarthroses points towards a platelet defect. This could be either isolated (defect of either number or function) or part of bone marrow failure. The latter also explains the pallor and could be either due to a concurrent illness or a genetic syndrome, i.e. constitutional pancytopenia such as Diamond Schwachmann syndrome. If the platelet count is normal and aPTT is abnormal, von Willebrand's disease should be considered. If both platelet and coagulation tests are normal, vascular purpura is likely.
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