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Semin Thromb Hemost
DOI: 10.1055/a-2673-4266
Review Article

Thrombocytopenia after Hematopoietic Stem Cell Transplantation in Pediatrics and Adults: A Narrative Review Including Etiology, Management, Monitoring, and Novel Therapies

Amirali Kalantari    *
1   Pediatric Cell and Gene Therapy Research Center, Gene, Cell and Tissue Research Institute, Tehran University of Medical Sciences, Tehran, Iran
,
Zahra Karimizadeh    *
1   Pediatric Cell and Gene Therapy Research Center, Gene, Cell and Tissue Research Institute, Tehran University of Medical Sciences, Tehran, Iran
,
Leila Jafari
1   Pediatric Cell and Gene Therapy Research Center, Gene, Cell and Tissue Research Institute, Tehran University of Medical Sciences, Tehran, Iran
,
Maryam Behfar
1   Pediatric Cell and Gene Therapy Research Center, Gene, Cell and Tissue Research Institute, Tehran University of Medical Sciences, Tehran, Iran
,
Amir Ali Hamidieh 
1   Pediatric Cell and Gene Therapy Research Center, Gene, Cell and Tissue Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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Abstract

Thrombocytopenia following hematopoietic stem cell transplantation (HSCT) is a common complication that is associated with a remarkable increase in morbidity and mortality. Post-HSCT thrombocytopenia is a multifactorial condition with several mechanisms, including reduced platelet production in bone marrow, immune-mediated platelet destruction, and consumptive thrombocytopenia. Graft-versus-host disease (GVHD), medications, infections, and autoimmune mechanisms are potential risk factors for post-HSCT thrombocytopenia. Management of post-HSCT thrombocytopenia primarily focuses on supportive care through platelet transfusions. Moreover, immunosuppressive agents are used to target immune-mediated mechanisms. Thrombopoietin receptor agonists and complement inhibitors are novel treatment options with promising results and fewer side effects. However, further research is essential to establish treatment protocols and improve patient care. In this review, we provide a better understanding of the pathophysiology and risk factors associated with post-HSCT thrombocytopenia for early detection and intervention, ultimately aiming to reduce complications.

Keywords

hematopoietic stem cell transplantation - thrombocytopenia - thrombopoietin receptor agonists

Data Availability

All data generated or analyzed during this study are included in this published article.


Declaration of GenAI Use

During the preparation of this article, the authors used ChatGPT (OpenAI) to assist with language and grammar improvements. The authors have thoroughly reviewed and edited the content and take full responsibility for the final version of the article.


* These authors contributed equally to this article and are designated as co-first authors.




Publication History

Received: 24 April 2025

Accepted: 30 July 2025

Accepted Manuscript online:
01 August 2025

Article published online:
19 August 2025

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