Immune thrombocytopenia in infants usually mild, self-limiting

Parents of infants with immune thrombocytopenia (ITP) need not worry too much as the disease is almost always self-limiting and transient, with most cases not requiring treatment, suggests a Singapore study. In addition, chances of developing chronic ITP are slim.

“[O]ur experience shows that ITP in infancy deserves unique attention,” the researchers said. “It is generally a mild disease, [and] the great majority of patients recover without treatment.”

This retrospective study included 22 infants (1–12 months of age) and 30 toddlers (13–47 months of age) with an ITP diagnosis from a single centre during a 13-year period. Researchers compared the demographics, severity of bleeding, platelet counts, duration of illness, development of chronic ITP, treatment, and association with recent vaccination between the two groups.

Infants with ITP exhibited minor or mild bleeding (n=19, 86.4 percent) and hardly required treatment (n=7, 31.8 percent). Their thrombocytopenia also resolved at a mean of 1.90 months after diagnosis. Apart from age, infants and toddlers had similar sex ratio, bleeding severity, platelet counts, and proportion that required treatment. [Singapore Med J 2025;66:20-23]

Fewer infants developed chronic ITP compared with toddlers (1/22 vs 9/30; p=0.032), but more infants had been previously vaccinated in the preceding 6 weeks before ITP diagnosis (13/22 vs 1/30; p<0.001).

Previous studies

“The medical literature contains very few observations about ITP in infancy,” according to the researchers. “Of the five articles published in the last 20 years, four defined infancy as age up to 24 months old.” [Pediatr Blood Cancer 2004;42:109-112; Eur J Haematol 2006;77:334-337; Acta Med Iran 2007;45:510-512; Iran J Pediatr Hematol Oncol 2011;1:104-110]

Some 445 children were assessed, with serious bleeding ranging from 8 percent to 41 percent. Bone marrow aspiration was mandatory in three series despite current guidelines stating that such diagnostic procedure is not necessary in childhood. [Iran J Pediatr Hematol Oncol 2016;6:24-31; Blood Adv 2019;3:3780-3817]

In addition, most patients (95 percent) received immunomodulatory agents. Children were also treated with intravenous immunoglobulin or corticosteroids, but up to 8 percent received anti-D immune globulin, azathioprine, or cyclosporine.

“Thus, the published data suggest that infants with ITP are managed very aggressively in terms of diagnostic workup, and there is a reluctance to withhold pharmacotherapy, which are different from our experience,” the researchers said. 

Vaccination

An average child in Singapore can receive up to 26 vaccines in either single shots or combination vaccines before their first birthday.

“It is difficult to tell if a recent exposure to a vaccine or several vaccines is aetiologically related,” the researchers said.

In case–control studies, measles–mumps–rubella vaccine, administered within 6 weeks prior to the emergency of thrombocytopenia, is the only agent found to have significant associations with the occurrence of ITP. [Br J Clin Pharmacol 2003;55:107-111; Drug Saf 2010;33:65-72]

"Even so, the attributable risk of developing ITP after the vaccine is one in 25,000 vaccinations,” the researchers said.

“More studies are required to expand our understanding of the impact of ITP in infants for its optimal management,” they noted.