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European Journal of Pediatrics

, Volume 178, Issue 6, pp 957–960 | Cite as

Routine funduscopy in immune thrombocytopenic purpura—is it really necessary?

  • Tali Capua
  • Neta CohenEmail author
  • Adi Anafy
  • Dana Greisman
  • Dror Levin
  • Ayelet Rimon
Short Communication

Abstract

Immune thrombocytopenic purpura (ITP) is a common cause of symptomatic thrombocytopenia in children, most of whom present with cutaneous and mucosal bleeding. Complications, such as intracranial hemorrhage and occult hemorrhage from various sites, are rare, and retinal hemorrhage is exceptionally rare. Our institutional clinical practice guidelines for managing ITP in the pediatric emergency department (PED) include routine funduscopy. The aim of this retrospective case series is to provide evidence-based recommendations for a tertiary care PED work-up of ITP, with special emphasis on the guidelines for funduscopy. The medical records of all pediatric patients diagnosed with ITP over a 4-year period (2013–2016) who had a platelet count < 50,000/mm3 were retrieved and reviewed. Seventy-five patients with thrombocytopenia (platelet count < 50,000/mm3) were diagnosed as having ITP in the PED. Sixty-one (79%) of these patients underwent funduscopy and retinal hemorrhage was ruled out in all of them, indicating that retinal hemorrhage as a complication of ITP is very rare.

Conclusion: Our data suggest that funduscopy should not be performed routinely on pediatric ITP patients, but rather be reserved for those who present with concurrent anemia or visual complaints.

What is Known:

Many internal institutional protocols in Israel call for retinal hemorrhage bleeding surveillance in work up of ITP. Our study found no case of ITP with retinal bleeding.

What is New:

Many internal institutional protocols in Israel call for retinal hemorrhage bleeding surveillance in work up of ITP. Our study found no case of ITP with retinal bleeding.

Keywords

Funduscopy Immune thrombocytopenic purpura Occult bleeding Retinal hemorrhage 

Abbreviations

CBC

Complete blood count

ICH

Intracranial hemorrhage

ITP

Immune thrombocytopenic purpura

PED

Pediatric emergency department

PICU

Pediatric intensive care unit

SD

Standard deviation

Notes

Authors’ contributions

Tali Capua and Neta cohen contributed significantly and equally to the planning of the study and the study desing, performed statsitical analysis and did major manuscript preparation. Adi Anafy and Dana Greisman collected data. Dror Levin contributed for manuscript expertise. Ayelet Rimon contributed significantly for manuscript editing and expertise.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Pediatric Emergency Medicine, Dana-Dwek Children’s HospitalTel Aviv Sourasky Medical CenterTel-AvivIsrael
  2. 2.Sackler School of MedicineTel-Aviv UniversityTel-AvivIsrael
  3. 3.Pediatric Hemato-oncology Department, Dana-Dwek Children’s HospitalTel Aviv Sourasky Medical CenterTel AvivIsrael

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