Flores, A (2016) American Journal of Hematology, (Link to Abstract)
Immune thrombocytopenia (ITP) is one of the most common causes of severe thrombocytopenia in the pediatric population and is associated with the risk of severe bleeds, although these are encountered infrequently. This is a prospective cohort study investigating the incidence of occult hemorrhage in children with severe immune thrombocytopenia (ITP), defined as a platelet count < 10. Each enrolled patient underwent a bleeding severity assessment, urinalysis, fecal occult blood testing and non-contrast brain MRI upon initial diagnosis or symptomatic relapse.
27% of patients were found to have occult hematuria, and one child was identified with microbleeding in the superficial cortex of the left frontal lobe. However, no association was found between occult hemorrhage and overt bleeding manifestations or increased risk of subsequent bleeds. Further study is needed to elucidate the potential risks of occult bleeds in this population.
* Children with severe ITP are at risk of occult bleeds, which pose a potential risk to this population. These seem unrelated to major bleeds though and therefore screening seems unnecessary according to current knowledge.