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Immune thrombocytopenic purpura (ITP), also known as idiopathic thrombocytopenic purpura, is a rare bleeding disorder caused by increased peripheral platelet destruction. The laboratory and clinical criteria for establishing the diagnosis of acute ITP in children and adolescents are widely accepted. Treatment options for ITP remain controversial. Retrospective data analysis of patients with acute ITP referred to the pediatric Hematology/Oncology Clinic at Sioux Valley Children's Specialty Clinic, seen from August 1998 to December 2004. Fourteen patients out of 25 presented with acute ITP, and had platelet count < or = 10 x 10(9)/L. Life threatening hemorrhage did not occur with any of these patients. Eleven of the analyzed 25 (44%) patients had thrombocytopenia resolve within six months of diagnosis. Nine patients (9/25, 36%) continue to be thrombocytopenic at one year from diagnosis, but without significant bleeding episodes. The clinical presentation, duration and severity of disease in patients with acute ITP seen in our Center are similar to those described in recently published studies. Our approach to treatment differed when compared with other studies. The difference in treatment may be due to patients' significant geographic distance from a tertiary care center, combined with unavailability of necessary treatment in local health institutions.