Purpura , Ecchymosis, Thrombocytopenia
These conditions can be misdiagnosed as SBS, or supporting symptoms of "abuse"

dictionary.com :
Purpura--any of several hemorrhagic states characterized by patches of purplish discoloration resulting from extravasation of blood into the skin and mucous membranes —see THROMBOCYTOPENIC PURPURA

Ecchymosis--1. the purple or black-and-blue area resulting from a bruise
2. the escape of blood from ruptured blood vessels into the surrounding tissue to form a purple or black-and-blue spot on the skin

Thrombocytopenia--persistent decrease in the number of blood platelets that is often associated with hemorrhagic conditions called also thrombopenia —throm·bo·cy·to·pe·nic /-nik/ adjective

http://www.medicaljournal-ias.org/15_4/Sakha.pdf
HEPATITIS B VACCINATION AND INFANTILE IDIOPATHIC
THROMBOCYTOPENIC PURPURA
KAZEM SAKHA*
ARMAN MALEKIAN*
SAID ASLANABADI*
SUMMARY: Since 1993, Iranian infants have been routinely vaccinated against hepatitis B. In the period of 1993-2002, twenty five children with infantile thrombocytopenic purpura (ITP) were admitted to the Childrens Medical Center in Tabriz, Iran whereas between 1982 and 1992, only two cases were hospitalized with the same diagnosis. This suggests a cause and effect relationship between hepatitis B vaccination and ITP.

INTRODUCTION
ITP is an autoimmune disorder leading to a reduction of the number of peripheral blood platelets (1). For reasons not well understood, autoantibodies are generated against glycoproteins GpIb/Ix and GpIIb/IIIa and are stiuated on the surface of the platelets. Attachment of autoantibodies to these surface antigens leads to phagocytosis or
complement-induced lysis of the platelets involved. This process may also involve megakaryocytes, leading to a decrease in platelet production (2,4). Autoantibodies against platelet surface antigens have been detected in 75% of the patients (2,3).
ITP appears in two forms: acute or chronic. The acute form occurs predominantly in children. 85% of cases are preceded by a viral infection. The disorder may last for one or two months period and is self limited. Mumps, measles, rubella vaccine (MMR) has been implicated in the etiology of ITP (5-10). In Finland, 23 cases of ITP were reported among 70.000 MMR vaccines. The authors speculated that the vaccine leads to generation of antiplatelet antibodies (1). In another study, one case of ITP was recorded among 24.000 MMR vaccines (10).
Occurrence of ITP following DPT vaccination is rare. In a British study, only two cases were reported (8), this data is not significant when the widespread administration of
DPT vaccine is considered. Two cases of ITP have been reported in conjunction with small pox vaccination (12). Small numbers of cases following recombinant HBV have
been reported (13). There is no report of ITP following plasma-derived hepatitis vaccine (11).

MATERIALS AND METHODS
ITP cases between 1992 and 2002
The files of all 25 infants under six months of age, hospitalized at the Childrens Medical Center in Tabriz, Iran, between 1993 and 2002 and discharged with ITP as the final diagnosis were included in the present study. The diagnosis was established based on the clinical findings (purpura, ecchymosis), platelet count, bone marrow findings and exclusion of other causes.
*From Department of Pediatrics, Tabriz University of Medical Sciences, Tabriz, Iran.
Medical Journal of Islamic World Academy of Sciences 15:4, 149-151, 2005

http://adc.bmj.com/cgi/content/abstract/84/3/227
Article
Short report

Idiopathic thrombocytopenic purpura and MMR vaccine E Millera, P Waighta, C P Farringtonb, N Andrewsa, J Stowec, B Taylorc

a Immunisation Division, Public Health Laboratory Service Communicable Disease Surveillance Centre, Colindale, London NW9 5EQ, UK, b Department of Statistics, The Open University, Milton Keynes MK7 6AA, UK, c Royal Free Campus, Royal Free and University College Medical School, University College London, London NW3 2PF, UK

Correspondence to: Dr Miller e.miller@phls.co.uk

Accepted 11 April 2000

http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=12534647&dopt=AbstractPlus
A CAUSAL ASSOCIATION BETWEEN MEASLES---mumps-rubella (MMR) vaccine and idiopathic thrombocytopenic purpura (ITP) was confirmed using immunisation/hospital admission record linkage. The absolute risk within six weeks of immunisation was 1 in 22 300 doses, with two of every three cases occurring in the six week post-immunisation period being caused by MMR.

1: Br J Clin Pharmacol. 2003 Jan;55(1):107-11.
MMR vaccine and idiopathic thrombocytopaenic purpura.
Black C, Kaye JA, Jick H.

Department of Public Health, Aberdeen University, Aberdeen, UK. corri.black@abdn.ac.uk

AIMS: To estimate the relationship between idiopathic thrombocytopaenic purpura (ITP) and the measles, mumps and rubella (MMR) vaccination in children; calculating the relative risk estimate for ITP with in 6 weeks after MMR vaccination and the attributable risk of ITP within 6 weeks after MMR vaccination. METHODS: Using the General Practice Research Database we identified children with a first-time diagnosis of ITP from a base population of children aged less than 6 years between January 1988 and December 1999. After describing the characteristics of all the children identified with ITP, we focused on cases aged 13-24 months to perform a population-based, case-control analysis to estimate the relative risk of developing ITP within 6 weeks after MMR vaccination. We also calculated the risk of ITP attributable to the MMR vaccination. RESULTS: Sixty-three children with a first time diagnosis of ITP were identified; 23 cases were between 13 and 24 months old. The relative risk estimate for ITP within 6 weeks after MMR vaccination, compared to the combined group of unvaccinated children and children vaccinated with MMR more than 26 weeks previously was 6.3 (95% CI 1.3-30.1). The attributable risk of developing ITP within 6 weeks after MMR vaccination was estimated to be 1 in 25,000 vaccinations (95% confidence interval 21,300, 89,400). CONCLUSION: This study confirms the increased risk of ITP within 6 weeks after MMR vaccination. However, the attributable risk of ITP within 6 weeks after MMR vaccination is low.

PMID: 12534647 [PubMed - indexed for MEDLINE]

http://www.ingentaconnect.com/content/mksg/ejh/2006/00000077/00000004/art00010
Acute immune thrombocytopenic purpura in infants: associated factors, clinical features, treatment and long-term outcome
Authors: Wang, Jiaan-Der; Huang, Fang-Liang1; Chen, Po-Yen2; Wang, Teh-Ming3; Chi, Ching-Shiang1; Chang, Te-Kau1
Source: European Journal of Haematology, Volume 77, Number 4, October 2006 , pp. 334-337(4)

Abstract:
Wang J-D, Huang F-L, Chen P-Y, Wang T-M, Chi C-S, Chang T-K. Acute immune thrombocytopenic purpura in infants: associated factors, clinical features, treatment and long-term outcome.

The natural course of acute immune thrombocytopenic purpura (ITP) in infants is poorly described in the literature. A retrospective study of 17 consecutive patients <1?yr of age admitted and treated for acute ITP between 1996 and 2005 was conducted. We investigated their demographics, vaccination history, clinical features, laboratory examinations, response to treatment and long-term outcome. There were 11 male and six female infants. Their ages ranged from 24?d to 12?months with a median of 3?months. All infants presented with petechiae and/or ecchymoses. Fourteen cases had platelet counts below 20?×?109/L at the time of admission. They all had good response to a single course of treatment (14/17) or multiple courses of treatment (3/17). None had progressed into chronic ITP. Seven infants had a causal relationship with immunization, five associated with hepatitis B, one diphtheria-pertussis-tetanus, one diphtheria-tetanus-acellular pertussis-inactivated poliovirus vaccine-conjugated Haemophilus influenza vaccines. These seven infants responded to treatment within 3-9?d after therapy with intravenous immunoglobulin, high-dose methylprednisolone or oral steroids. Re-boosters with vaccines revealed no recurrence of the disease in all of these seven patients. The study suggests that further immunization is not contraindicated in infants experiencing acute ITP associated with vaccines.

http://www.chiro.org/LINKS/ABSTRACTS/Issues_in_Chiropractic_Pediatrics.shtml

Thrombocytopenia:
vaccinations, drugs, or disease-caused
Abnormal bleeding, bruising, subdural hematomas, retinal hemorrhages
(symptoms falsely attributed exclusively to Shaken Baby Syndrome)

" Generally speaking, in humans, a normal platelet count ranges from 150,000 and 450,000 per mm3 (microlitre).[1] These limits, however, are determined by the 2.5th lower and upper percentile, and a deviation does not necessarily imply any form of disease. The number of platelets in a blood sample also decreases rather quickly with time and a low platelet count may be caused by a delay between sampling and analysis." --Wikipedia

Photos of a condition associated with vaccinations, drugs, and original disease from unknown causes, resulting in abnormal bruising, hemorrhagic conditions, retinal hemorrhage, subdural hematoma, bleeding in the brain (symptoms associated with SBS cases, whose "experts" falsely claim are exclusive to "shaken babies")

Online pictures of thrombocytopenia from different medical websites

Thrombocytopenia: Retinal Hemorrhages

Photos of a condition associated with vaccinations, drugs, and original disease from unknown causes, resulting in abnormal bruising,
hemorrhagic conditions, retinal hemorrhage, subdural hematoma, bleeding in the brain

Types of retinal hemorrhages

http://www.google.com/search?q=thrombocytopenia+%2B+retinal+hemorrhage (37,100 hits)

Massive bilateral vitreoretinal hemorrhage in patient with chronic ...
thrombocytopenia [4]. The retinal hemorrhages were generally flame-shaped, but were occasionally
either subhyaloid or had broken through the internal ...
www.springerlink.com/index/WU362673512801QW.pdf

Vaccine-induced THROMBOCYTOPENIA journal articles (a small sample from http://scholar.google.com)

• OBJECTIVES: Adverse events and positive re-challenge of symptoms reported in the scientific literature and to the Vaccine Adverse Event Reporting System (VAERS) following hepatitis B vaccination (HBV) were examined. METHODS: The VAERS and PubMed (1966-2003) were searched for autoimmune conditions including arthritis, rheumatoid arthritis, myelitis, optic neuritis, multiple sclerosis (MS), Guillain Barré Syndrome (GBS), glomerulonephritis, pancytopenia/thrombocytopenia, fatigue, and chronic fatigue, and Systemic Lupus Erythematous (SLE) following HBV. RESULTS: HBV was associated with a number of serious conditions and positive re-challenge or significant exacerbation of symptoms following immunization. There were 415 arthritis, 166 rheumatoid arthritis, 130 myelitis, 4 SLE, 100 optic neuritis, 101 GBS, 29 glomerulonephritis, 283 pancytopenia/thrombocytopenia, and 183 MS events reportedfollowing HBV A total of 465 positive re-challenge adverse events were observed following adult HBV that occurred sooner and with more severity than initial adverse event reports. A case-report of arthritis occurring in identical twins was also identified. CONCLUSIONS: Evidence from biological plausibility, case-reports, case-series, epidemiological, and now for positive re-challenge and exacerbation of symptoms, and events in identical twins was presented. One would have to consider that there is causal relationship between HBV and serious autoimmune disorders among certain susceptible vaccine recipients in a defined temporal period following immunization. In immunizing adults, the patient, with the help of their physician, should make an informed consent decision as to whether to be immunized or not, weighing the small risks of the adverse effects of HBV with the risk of exposure to deadly hepatitis B virus.

• 1: N Y State J Med. 1972 Feb 15;72(4):499.Links
  Thrombocytopenia associated with rubella vaccination.
  Bartos HR.

• PEDIATRICS Vol. 89 No. 2 February 1992, pp. 318-324
  

  The Ricochet of Magic Bullets: Summary of the Institute of Medicine Report, Adverse Effects of Pertussis and Rubella Vaccines
  Christopher P. Howson PhD1 and Harvey V. Fineberg MD, PhD1

  1 From the Institute of Medicine of the National Academy of Sciences, Washington, DC. Dr Howson is Deputy Director of the Division of International Health of the Institute of Medicine and Dr Fineberg is dean of the Harvard School of Public Health, Boston, MA.

  On July 3, 1991, the National Academy of Sciences' Institute of Medicine (IOM) released a reported entitled, Adverse Effects of Pertussis and Rubella Vaccines,1 in response to a congressional request to review evidence about a set of serious adverse events and immunization with pertussis and rubella vaccines. The request originated in the 1986 National Childhood Vaccine Injury Act (Public Law 99-660), whose primary purpose was to establish a federal compensation scheme for persons potentially injured by a vaccine; Section 312 of Public Law 99-660 called for the IOM review.

  Over the course of its 20-month study, the 11-member interdisciplinary committee constituted by IOM to conduct the review examined altogether 18 adverse events for pertussis vaccine—infantile spasms; hypsarhythmia; aseptic meningitis; acute encephalopathy; chronic neurologic (permanent brain) damage; deaths classified as sudden infant death syndrome (SIDS); anaphylaxis, autism; erythema multiforme or other rashes; Guillain-Barré syndrome (polyneuropathy); peripheral mononeuropathy; hemolytic anemia; juvenile diabetes; learning disabilities and hyperactivity; protracted inconsolable crying or screaming; Reye's syndrome; shock and "unusual shock-like state" with hypotonicity, hyporesponsiveness, and short-lived convulsions (usually febrile); and thrombocytopenia—and 4 adverse events for rubella vaccine—acute arthritis; chronic arthritis; radiculoneuritis and other neuropathies; and thrombocytopenic purpura. In conducting its review, the committee recognized that its charge was to focus on questions of causation and not broader topics, such as cost-benefit or risk-benefit analyses of vaccination.

  This summary begins with a brief history of events leading to the IOM study, then reviews the methods used by the committee to evaluate the evidence, summarizes the committee's conclusions for these adverse events, and offers directions for future investigation of adverse events in connection with widely used health interventions, such as vaccination.
  Submitted on November 5, 1991
  Accepted on November 21, 1991

• Hepatitis and death following vaccination with 17D-204 yellow fever vaccine - all 3 versions »
  RC Chan, DJ Penney, D Little, IW Carter, JA … - The Lancet, 2001 - Elsevier
  ... to by: Rarity of adverse effects after 17D ... on Jan 31, he developed thrombocytopenia,
  clotting abnormalities ... not support previous yellow fever vaccination in our ...

• Comment on:
  Lancet. 1994 Nov 5;344(8932):1293.

  Thrombocytopenia reported in association with hepatitis B and A vaccines.
  Meyboom RH, Fucik H, Edwards IR.

http://tinyurl.com/4z2za8

Drug-Induced THROMBOCYTOPENIA

http://www.neurology.org/cgi/content/abstract/54/6/1240

Neurologic complications in immune-mediated heparin-induced thrombocytopenia
C. Pohl, MD, U. Harbrecht, MD, A. Greinacher, MD, I. Theuerkauf, MD, R. Biniek, MD, P. Hanfland, MD and T. Klockgether, MD

From the Departments of Neurology (Drs. Pohl and Klockgether), Transfusion Medicine (Drs. Pohl, Harbrecht, and Hanfland) and Pathology (Dr. Theuerkauf), Rheinische Friedrich Wilhelms Universität, Bonn; Institute of Immunology and Transfusion Medicine (Dr. Greinacher), Ernst Moritz Arndt Universität Greifswald; and the Rheinische Landesklinik Bonn (Dr. Biniek), Bonn, Germany.

Address correspondence and reprint requests to Dr. C. Pohl, Department of Neurology, University of Bonn, Sigmund-Freud-Straße, D-53105 Bonn, Germany; e-mail: c.pohl@uni-Bonn.de

OBJECTIVE: To evaluate neurologic complications in patients with immune-mediated heparin-induced thrombocytopenia (HIT) with respect to incidence, clinical characteristics, outcome, and therapy.

METHODS: One hundred and twenty consecutive patients with immune-mediated HIT were recruited over a period of 11 years and studied retrospectively for the occurrence of neurologic complications. Diagnosis of HIT was based on established clinical criteria and confirmed by detection of heparin-induced antibodies using functional and immunologic tests.

RESULTS: Eleven of the 120 patients (9.2%) presented with neurologic complications; 7 suffered from ischemic cerebrovascular events, 3 from cerebral venous thrombosis, and 1 had a transient confusional state during high-dose heparin administration. Primary intracerebral hemorrhage was not observed. The relative mortality was much higher (Chi-square test, p < 0.01) in HIT patients with neurologic complications (55%) as compared to patients without neurologic complications (11%). The mean platelet count nadir in neurologic patients was 38 ± 25 x 109/l on average, and was lower in patients with fatal outcome compared to those who survived (21 ± 13 x 109/l versus 58 ± 21 x 109/l; p < 0.05, Wilcoxon test). In three patients neurologic complications preceded thrombocytopenia. There was a high coincidence of HIT-associated neurologic complications with other HIT-associated arterial or venous thrombotic manifestations.

CONCLUSION: Neurologic complications in HIT are relatively rare, but associated with a high comorbidity and mortality. HIT-associated neurologic complications include cerebrovascular ischemia and cerebral venous thrombosis. They may occur at a normal platelet count

http://medicineworld.org/physicians/hematology/thrombocytopenia.html

Figure 2. Computed tomography demonstrating large right frontal intracerebral hemorrhage.