Prognostic Factors for Poor Outcome in Immune Thrombocytopenia

Immune thrombocytopenia (ITP) is an acquired autoimmune disorder characterized by increased platelet destruction and impaired platelet production. Although most acute cases—particularly in children—resolve spontaneously or respond readily to first-line therapy, a significant subset of adult patients develop chronic, refractory, or complicated disease. Early recognition of poor prognostic factors is essential to guide management, optimize treatment sequencing, and prevent severe bleeding or unnecessary therapeutic exposure. This narrative review summarizes recent evidence (2018–2025) concerning the clinical, biological, immunological, and therapeutic determinants associated with adverse outcomes in adult ITP. We emphasize factors related to chronicity, treatment resistance, and bleeding risk to inform the development of personalized, risk-adapted therapeutic strategies.

Keywords: Immune Thrombocytopenia, Prognosis, Predictive Factors, Chronic ITP, Refractory ITP, Bleeding Risk.