David Kuter, MD, DPhil, Director of Clinical Hematology at Massachusetts General Hospital and Professor of Medicine at Harvard Medical School, discusses cognitive impairment in patients with immune thrombocytopenia (ITP).
ITP is an autoimmune bleeding disorder characterized by too few platelets in the blood. Symptoms may include bruising, nosebleeds or bleeding in the mouth, bleeding into the skin, and abnormally heavy menstruation. It has been traditionally managed with corticosteroids, medicines that stimulate the bone marrow to increase platelets, and immunoglobulin infusions to restore critically low platelet counts.
Data presented at the European Hematology Association (EHA) 2026 meeting highlights that focusing on platelet counts alone does not fully capture the disease burden of ITP. The objective of the study was to determine the frequency, nature, and severity of cognitive impairment in chronic primary ITP in a real-world setting.
Of 104 patients screened, 97 were eligible to participate in the study and completed the Cognitive Brief Battery (CBB) test, a validated test evaluating psychomotor function, visual attention, visual learning, and visual working memory. The median duration of ITP was 10 years. 82 patients reported receiving active ITP treatment at index, including TPO-RAs, corticosteroids, other immunosuppressants, fostamatinib, rituximab, and/or other. Median platelet count was 143×109/L and median hemoglobin was 139 g/L. 80 participants had comorbidities, including arterial hypertension, anxiety, obesity, depression, and hypercholesterolemia. The mean ITP bleeding scale total score was 0.04 and mean scores for FACIT-Fatigue, ITP-PAQ psychological health (PH), and ITP-PAQ overall QOL were 37, 76, and 65, respectively.
Clinically important cognitive impairment was observed in 26% of patients, with 68% aged less than 65 years. Among the 97 patients evaluated, 7 patients, ages 39-78 years, had z-score of less than or equal to -1 for both composite scores; 12 patients, aged 25-75 years, had z-score of less than or equal to -1 for learning/working memory only, and 6 patients, aged 25-80 years, had z-scores of less than or equal to -1 for psychomotor function/attention only.
Overall, the analyses showed that patients continue to experience persistent fatigue and cognitive impairment even with stable platelet counts. This highlights the need for more comprehensive disease management in ITP that focuses more on a patient’s quality of life beyond hematologic lab results.
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To learn more about ITP and other rare autoimmune, conditions, visit https://checkrare.com/diseases/autoimmune-autoinflammatory-disorders/
