The impact of Mycoplasma pneumoniae infection on children with immune thrombocytopenia treated with thrombopoietin receptor agonists: a real-world study from China

Mycoplasma pneumoniae (M. pneumoniae), as one of the susceptible pathogens during childhood, may lead to severe mycoplasmal pneumonia and even pulmonary embolisms, which could affect platelet count and increase the risk of thrombosis in patients who used thrombopoietin receptor agonists (TPO-RAs) treatment. We prospectively collected data on persistent/chronic ITP children prescribed TPO-RAs during the M. pneumoniae infection from August 2023 to December 2023. There were 33 patients enrolled (21 males), with a median age of 7.69 years (range 4.94 to 10.99). Before the start of M. pneumoniae infection, 54.5% of patients (18/33) were treated with eltrombopag, 36.4% (12/33) with avatrombopag, 6.1% (2/33) with hetrombopag, and 3.0% (1/33) with romiplostim. In our study, 63.6% (21/33) of the patients showed a transient decrease in platelet count, while 36.4% (12/33) showed a transient increase. Thrombocytosis was observed in 5 patients. One patient who used eltrombopag presented with a headache for 3 days and was diagnosed with cerebral sinus thrombosis during M. pneumoniae infection. In conclusion, the effect of M. pneumoniae infection on PLT is bidirectional and unstable, and the risk of thrombosis may be increased, especially in TPO-RA-treated patients.