Routine Fundoscopy in Immune Thrombocytopenic Purpura – Is it Really Necessary?

Neta Cohen 1 Tali Capua 1 Adi Anafi 2 Dana Greisman 4 Dror Levin 3 Ayelet Rimon 1
1Paediatric Emergency Medicine,, Dana-Dwek Children’s Hospital,Tel Aviv Sourasky Medical Center, afficated to Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel., Tel Aviv, Israel
2Department of pediatric, Dana-Dwek Children’s Hospital, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel., Tel Aviv, Israel
3Paediatric Hemato-oncology Department, Dana-Dwek Children’s Hospital, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel., Tel Aviv, Israel
4Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel., Tel Aviv, Israel

Background: Immune Thrombocytopenic Purpura (ITP) is a common cause of symptomatic thrombocytopenia in children. Most of them present with cutaneous and mucosal bleeding. Rare complications are intra cranial haemorrhage (ICH) and occult haemorrhage from different sites; include retinal haemorrhage, which is exceptionally rare. Our institutional clinical practice guidelines for managing ITP in the paediatric emergency department (PED) include routine fundoscopy.

Objectives: Our goal is to provide evidence based recommendations for PED workup of ITP, with a special emphasis regarding the guidelines for fundoscopy.

Methods: A retrospective review of all patients diagnosed with ITP with a platelet count under 50,000/mm3 in a tertiary care paediatric emergency department over a 4-year period (2013-2016).

Results: During the 4-year study period, a total of 322 patients had a thrombocytopenia and 75 were diagnosed with severe ITP (platelets<50, 000) in the PED. Fundoscopy was performed in 61 (79%) patients, and retinal hemorrhage was ruled out in all of them.

Conclusion: Retinal hemorrhages as a complication of ITP is very rare. We suggest performing fundoscopy only in ITP patients who have Anemia or visual complaints as a mean to reduce unnecessary consultations.









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