Occult hemorrhage in immune thrombocytopenia

Assessing clinical bleeding in patients with immune thrombocytopenia (ITP) and predicting future risk of major hemorrhage has proven to be a complicated task given the heterogeneity in bleeding manifestations. Although bleeding scales have been used for this purpose, they fail to account for occult or subclinical hemorrhage. Little is known about the frequency and clinical significance of occult hemorrhage in ITP and no formal investigations have been published on the subject. However, determining the prevalence and incidence of occult hemorrhage may shed light on our understanding of bleeding severity in both children and adults. This review explores the potential clinical significance, sites and methods of testing of subclinical microbleeding in ITP.