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

Tali Capua, Neta Cohen*, Adi Anafy, Dana Greisman, Dror Levin, Ayelet Rimon

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


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 fundus-copy. 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.

Original languageEnglish
Pages (from-to)957-960
Number of pages4
JournalEuropean Journal of Pediatrics
Issue number6
StatePublished - 2019
Externally publishedYes


  • Funduscopy
  • Immune thrombocytopenic purpura
  • Occult bleeding
  • Retinal hemorrhage


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