A significant number of pediatric patients with immune thrombocytopenia (ITP) have difficulties with fatigue, emotional and behavioral symptoms, and executive functioning, with each having an effect on quality of life (QoL), according to a paper published in the British Journal of Haematology.

Fatigue, minor cognitive impairment, and overall reduction in health-related QoL are concerns in adults with ITP, but no studies have previously measured emotional and behavioral issues among pediatric patients. Therefore, pediatric patients are generally treated with a “watch and wait” approach.

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For this study, researchers evaluated questionnaire data from pediatric patients with ITP, as well as from their parents, to determine whether the condition has implications for QoL, fatigue, and executive function, as well as whether any associations of these factors with ITP have implications for treatment decision making.

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Of 46 families invited to participate, 37 (corresponding to 37 children with ITP) returned at least 1 completed questionnaire. In total, 20 patients were male and 17 were female. The mean age was 9.8 years (range, 4.8-16.4). Five patients (14%) had persistent ITP, defined as having a duration between 3 and 12 months, and 32 patients (86%) had chronic disease, defined as having a duration of more than 12 months. Sixteen percent of patients were on active treatment and 51% of patients had undergone previous treatment.

Reports returned from parents suggested that 70.6% of patients had fatigue scores at least 1 standard deviation lower than the normative mean. In addition, 19.4% of patients were rated by their parents as having difficulties with executive functioning, compared with 6.6% of children in the general population. Emotional and behavioral issues were reported in 25.7% of patients.

The mean QoL score using the Kids ITP Tools test was 79.38 in self-reports and 78.19 in parental reports. QoL scores appeared to correlate with fatigue, emotional and behavioral issues, and executive functioning issues, though severity of bleeding and platelet counts did not.

“There is a need for a detailed, prospective, longitudinal study to assess fatigue, emotional and behavioural symptoms, and difficulties in executive functioning, in which the standardised measures used here are applied at several time points in the disease course of a large cohort of children with ITP,” the researchers wrote.


1.     Towner S, Berger ZE, Titman P, et al. Fatigue, executive function and psychological effects in children with immune thrombocytopenia: a cross‐sectional study [published online January 24, 2020]. Br J Haematol. doi:10.1111/bjh.16387