Considering the severity of their current symptoms, heavy menstrual bleeding (118 of 158 patients [75%]), thrombosis (25 of 34 patients [74%]), and fatigue (544 of 743 patients [73%]) were the 3 symptoms patients would most like to resolve.

Signs and symptoms physicians rated as having a high impact (5 or higher on a 7-point Likert scale, with 7 meaning “a great deal”) on quality of life were: blood in urine/stool (81%), profuse bleeding during surgery (79%), and menorrhagia (78%). Fifty-nine percent of physicians reported fatigue as having a high impact on quality of life.

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Overall, 80% of physicians felt ITP symptoms reduced quality of life, and 66% believed that ITP-related fatigue reduced quality of life. However, only 46% of physicians gave fatigue a rating of 5 or higher on the 7-point Likert scale. They also believe that fatigue increases as platelet levels decrease.

In a last assessment from the survey, patients expressed satisfaction with how their physicians were managing their disease (79% satisfaction). Furthermore, satisfaction was high between patients and physicians regarding communication (80% vs 88%), management (79% vs 86%), and understanding treatment goals (77% vs 90%).

In conclusion, the researchers note that patients report fatigue as the most frequent and most severe symptom burden of ITP, whereas physicians acknowledge that patients are greatly affected by fatigue but did not rate it as significant a problem as patients did. Other patient concerns are heavy menstrual bleeding, platelet count stability, and thrombosis. As fatigue is likely to increase as platelet counts decrease, fatigue may be essentially connected to disease activity, indicating that increasing platelet counts may improve this effect.

Although this study reveals that patients and physicians basically agree on the symptom burden of ITP, these results also indicate that a greater understanding of the interaction between platelet count, fatigue, and quality of life is needed.


Kruse C, Kruse A, Watson S, et al. Patients with immune thrombocytopenia (ITP) frequently experience severe fatigue but is it under-recognized by physicians: results from the ITP World Impact Survey (I-WISh). Poster presentation at: American Society of Hematology 60th Annual Meeting & Exposition; December 1-4, 2018; San Diego, CA. Abstract 2273.