Immune thrombocytopenia (ITP) in childhood is characterized by isolated thrombocytopenia without other hematologic abnormalities, with a platelet count below 100,000 per microliter, after ruling out other causes of thrombocytopenia. ITP is a disorder that can cause platelet destruction and increase the risk of bleeding. Previously referred to as idiopathic thrombocytopenic purpura, the term “immune thrombocytopenia” is now preferred, as some patients may present with minimal or no purpura or bleeding, and the condition is now recognized as immune-mediated.1

The incidence of ITP is estimated to range from two to five cases per 100,000 individuals in the pediatric population.2,3 In children, ITP often resolves spontaneously within three months; however, approximately 10 % to 20 % of cases progress to chronic ITP, defined as a persistent platelet count below 100,000 per microliter for >12 months after initial presentation.4 The standard management approach for children with minimal or no bleeding risk is "watchful waiting," which does not require pharmacologic intervention. For those exhibiting more severe bleeding symptoms, treatment options include glucocorticoids, intravenous immunoglobulin (IVIG), anti-D immune globulin, and thrombopoietin receptor agonists (TPO-RAs). In chronic cases, second-line therapies such as immunosuppressive agents or Rituximab may be considered. Currently, splenectomy is rarely performed in pediatric patients with ITP.5, 6, 7, 8

Before the advent of modern Western medicine, traditional Chinese medicine (TCM) served as a primary form of medical care in East Asia. This study presents a case of a child with chronic ITP who showed a limited response to glucocorticoids and IVIG but achieved a sustained platelet count through treatment with TCM.