What are the potential complications of ITP that I should monitor for in my patients?

Potential complications of immune thrombocytopenic purpura (ITP) to monitor in patients include bleeding events, relapse, and long-term impacts on platelet function and immune regulation. The primary and most immediate complication is bleeding, which can range from mild mucocutaneous bleeding such as bruising and petechiae to severe, potentially life-threatening hemorrhages including intracranial bleeding. This bleeding risk is directly related to the degree of thrombocytopenia and platelet dysfunction ².

Relapse of ITP is a significant concern, as highlighted by recent literature, which emphasizes the need for ongoing monitoring even after initial remission. Relapses can lead to recurrent thrombocytopenia and associated bleeding risks (Tran et al., 2025).

Chronic ITP may also predispose patients to complications related to long-term immune dysregulation, including increased susceptibility to infections due to immunosuppressive treatments and potential development of other autoimmune conditions (Tran et al., 2025). Additionally, treatment-related complications such as adverse effects from corticosteroids or immunosuppressants should be monitored ².

Rare but serious complications include thrombotic events, which paradoxically can occur despite low platelet counts, possibly due to platelet activation and endothelial dysfunction (Tran et al., 2025).

In summary, monitoring should focus on bleeding signs, relapse indicators, infection risk, treatment side effects, and vigilance for thrombotic complications.