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Too little emphasis has been placed upon bleeding signs in children with idiopathic thrombocytopenic purpura (ITP). The frequency, location, and severity of clinical bleeding should dominate management considerations and the actual platelet count should be de-emphasized. With the notable exception of intracranial bleeding, virtually all prior literature reports describing case series or randomized trials of ITP have not addressed or even mentioned bleeding signs in study subjects. Future clinical investigations in childhood ITP should include a careful description of bleeding manifestations in the study populations and should assess outcome in terms of bleeding signs, quality of life, toxicity of therapy, cost, and, incidentally, the platelet count.