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.