Fatigue in children and adolescents with immune thrombocytopenia

Rachael F. Grace*, Robert J. Klaassen, Kristin A. Shimano, Michele P. Lambert, Amanda Grimes, James B. Bussel, Vicky R. Breakey, Yves D. Pastore, Vandy Black, Kathleen Overholt, Rukhmi Bhat, Peter W. Forbes, Cindy Neunert

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Immune thrombocytopenia (ITP), an acquired autoimmune disorder of low platelets and risk of bleeding, has a substantial impact on health-related quality of life (HRQoL). Patients with ITP often report significant fatigue, although the pathophysiology of this is poorly understood. In this observational cohort of 120 children receiving second-line therapies for ITP, we assessed reports of fatigue using the Hockenberry Fatigue Scale. Children and adolescents with ITP reported a similarly high level of fatigue with 54% (29/54) of children and 62% (26/42) of adolescents reporting moderate-to-severe fatigue. There was no correlation between fatigue and age or gender. Adolescents with newly diagnosed and persistent ITP had higher mean fatigue scores than those with chronic ITP (P = 0·03). Fatigue significantly improved in children and adolescents by 1 month after starting second-line treatments, and this improvement continued to be present at 12 months after starting treatment. Fatigue scores at all time-points correlated with general HRQoL using the Kids ITP Tool, but did not correlate with bleeding symptoms, platelet count, or platelet response to treatment. Fatigue is common in children and adolescents with ITP and may benefit from ITP-directed treatment even in the absence of bleeding symptoms.

Original languageEnglish (US)
Pages (from-to)98-106
Number of pages9
JournalBritish Journal of Haematology
Issue number1
StatePublished - Oct 1 2020
Externally publishedYes


  • fatigue
  • immune thrombocytopenia
  • quality of life
  • rituximab
  • thrombopoietin receptor agonists

ASJC Scopus subject areas

  • Hematology


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