Platelet Recovery and Coexisting Conditions in Pediatric Immune Thrombocytopenia: Insights from a Tertiary Care Study

Abstract

Background/objectives: Immune thrombocytopenia (ITP) is a rare but significant hematologic disorder in children. While most pediatric ITP cases resolve spontaneously, some require intervention, and treatment responses with platelet recovery patterns can vary widely. We conducted a retrospective, three-year observational cohort study including 100 children (aged 5 months-17 years) diagnosed with ITP at a single tertiary center (January 2022-December 2024). The primary objective of this study was to characterize the clinical presentation, coexisting conditions, and short-term platelet response to first-line therapy in hospitalized children with newly diagnosed ITP.

Methods: Clinical data (demographics, presentation, and laboratory results) were collected at admission and throughout hospitalization, and outcomes were assessed at discharge.

Results: Our analysis showed a balanced urban-rural distribution overall; however, sex distribution differed by residence, with a slight female predominance in rural areas and an overwhelming male predominance in urban areas. Over 40% of patients were under 5 years old. Platelet counts at presentation ranged from 3 × 10⁹/L to 30 × 10⁹/L, yet nearly all children showed substantial platelet count recovery by hospital discharge under first-line therapy. Most patients had additional minor clinical findings at admission, but these were considered concurrent rather than causative factors, in accordance with current hematology guidelines. These conditions were considered coexisting clinical conditions or concurrent findings rather than definitive secondary causes of ITP, in accordance with established hematological guidelines. These findings reflect only short-term, in-hospital outcomes and may not be generalizable to all children with ITP, particularly milder or outpatient cases.

Conclusions: Our three-year cohort study underscores that pediatric ITP often presents in very young children with concurrent conditions, but standard first-line treatment leads to robust platelet recovery by discharge. These findings highlight the importance of comprehensive initial evaluation and supportive care in managing pediatric ITP.

Keywords: hematologic disorder; immune thrombocytopenia; observational study; petechiae and ecchymoses; platelet recovery.

Figure 1

Percent of Male/Female patients in different age ranges.

Figure 2

Number of platelets in male/female patients at admission.

Figure 3

Symptom prevalence.

Figure 4

Localization of the most prevalent symptoms (with percentage values indicated for each site of bleeding).

Figure 5

Clinical presentation of petechiae and ecchymoses in selected patients. All images are original and were obtained from patients included in our study, with prior written informed consent from parents or legal guardians.

Figure 6

Sex-Based Anatomical Distribution of Petechiae and Ecchymoses in Patients with Immune Thrombocytopenia.