A 10-year-old boy presented with shortness of breath, hepatosplenomegaly, bleeding gums and a spreading petechial rash. He had non-specific complaints including lethargy for the previous 3 months but had not required hospital treatment and had no specific diagnosis. The week before admission he had developed a petechial rash and low-grade fever, but otherwise felt well, and was reviewed by his GP who sent routine bloods. His parents confirmed with his GP that it was acceptable to continue their holiday plans while awaiting the blood results. He had a proposed review scheduled after return from holidays a week later. He presented to the local A&E department at the holiday destination after a flight to visit his grandparents abroad. During the flight, his symptoms had worsened with onset of breathing difficulties, and his parents brought him to the local A&E after landing.