Clinical Experience of Immune Thrombocytopenia: A Single-Center Study from Nepal

Immune thrombocytopenia (ITP) is an acquired autoimmune disorder characterized by isolated thrombocytopenia due to increased platelet destruction and impaired platelet production. Although several international studies have explored the epidemiology and clinical outcomes of ITP, there is limited published evidence from Nepal. This study aimed to evaluate the clinical characteristics, treatment patterns, and outcomes of patients diagnosed with ITP in a single tertiary care center in Nepal. A retrospective observational study was conducted among patients diagnosed with immune thrombocytopenia between January 2024 and March 2026. Clinical presentation, laboratory findings, treatment modalities, and follow-up outcomes were reviewed from medical records. Secondary causes of thrombocytopenia and neonatal thrombocytopenia were excluded. Follow-up assessment was carried out to evaluate response to treatment and disease progression. A total of 30 patients were included in the study, comprising nine pediatric and twenty-one adult cases. Female predominance was observed with a male-to-female ratio of 0.76: 1. The most common clinical presentation was skin bleeding seen in 50% of cases, while generalized fatigue was present in 53%. Severe menorrhagia requiring emergency intervention was noted in two patients. Previous history of dengue fever was reported in 17% of patients. Platelet count below 20,000/µL at presentation was observed in 20% of patients, and antinuclear antibody positivity was detected in 7%. Hospital admission due to significant mucosal bleeding was observed in 40% of cases. Intravenous immunoglobulin (IVIG) was administered in only two patients because of limited availability and high cost. Steroids were the primary treatment modality in acute management. Only one patient underwent splenectomy. Complete remission was achieved in four patients, including one after splenectomy. No patient developed hematological malignancy or mortality during the follow-up period. Most patients with superficial bleeding manifestations did not require aggressive intervention. Steroids remained the cornerstone of therapy, while IVIG use was limited due to resource constraints. Platelet transfusion was commonly used in severe thrombocytopenia and bleeding episodes. Larger multicenter prospective studies are recommended to better understand the epidemiology and long-term outcomes of ITP in Nepal.