Original Articles
Vol. 18 No. 1 (2026): Mediterranean Journal of Hematology and Infectious Diseases
https://doi.org/10.4084/MJHID.2026.027

CLINICAL IMPACT OF ELTROMBOPAG-ASSOCIATED IRON CHELATION IN ADULTS WITH IMMUNE THROMBOCYTOPENIA: A MULTICENTER REAL-WORLD STUDY

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Published: February 28, 2026
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Immune Thrombocytopenia, Eltrombopag, iron deficiency, ferritin, fatigue

Authors

Ahmet Yigitbasi
ahmetyigitbasi23@gmail.com
https://orcid.org/0000-0001-6216-595X
Trakya University Department of Hematology, Edirne/Türkiye, Türkiye.
Elif Gulsum Umit
https://orcid.org/0000-0001-5589-3000
Trakya University Department of Hematology, Edirne/Türkiye, Türkiye.
Ufuk Demirci
https://orcid.org/0000-0001-6923-1470
Manisa Celal Bayar University Faculty of Medicine, Department of Hematology. , Türkiye.
Guray Aygun
https://orcid.org/0000-0001-5166-6716
Trakya University Department of Hematology, Edirne/Türkiye, Türkiye.
Nese Varli
University of Health Sciences Hamidiye Faculty of Medicine, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Internal Medicine. Istanbul, Türkiye, Türkiye.
Elif Aksoy
Kirklareli Training and Research Hospital, Hematology Clinic. Kirklareli, Türkiye, Türkiye.
Fehmi Hindilerden
https://orcid.org/0000-0002-6297-9555
University of Health Sciences Hamidiye Faculty of Medicine, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Hematology. Istanbul, Türkiye. , Türkiye.
Emine Gulturk
https://orcid.org/0000-0003-2836-6162
University of Health Sciences Hamidiye Faculty of Medicine, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Hematology., Türkiye.
Eren Arslan Davulcu
https://orcid.org/0000-0001-9262-2883
University of Health Sciences Hamidiye Faculty of Medicine, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Hematology. Istanbul, Türkiye, Türkiye.
Ahmet Muzaffer Demir
https://orcid.org/0000-0002-2073-5405
Trakya University Faculty of Medicine, Department of Hematology. Edirne, Türkiye., Türkiye.

Background: Eltrombopag (ELT) is an established thrombopoietin receptor agonist (TPO-RA) for chronic ITP, yet accumulating translational evidence indicates clinically relevant iron-chelating activity. Adult primary ITP–focused data characterizing longitudinal iron trajectories during ELT remain limited. We assessed whether ELT exposure is independently associated with iron deficiency (ID) in routine practice.

Methods: In this multicenter retrospective study, adults with ITP were evaluated with longitudinal monitoring of platelet count, ferritin, Tsat, Hb, and MPV. Within-patient change was defined as baseline minus follow-up (Δ). Outcomes were compared by ELT exposure and dose strata. Multivariable linear regression was used to identify independent determinants of Δ-ferritin, adjusting for age, gender, relapse status, and IRT.

Results: The cohort included 283 adults with ITP; 110 received ELT (median 25 months). ELT was associated with greater declines in ferritin and Tsat (p<0.001), with a dose-graded effect across 25–75 mg and earlier iron depletion at higher dose intensity. In relapsed patients not receiving ELT, mean Δ-ferritin was positive and did not differ by bleeding status. In multivariable linear regression, ELT was the dominant independent predictor of lower Δ-ferritin (B≈−79.8 µg/L, p<0.001), whereas age, gender, and relapse were not significant; IRT attenuated ferritin decline among ELT-treated patients but did not negate the ELT effect.

Conclusion: ELT exposure was independently associated with ID, supporting a clinically meaningful ELT-related iron chelation phenotype in routine practice. Monitoring and timely correction of ID during ELT therapy may mitigate a modifiable contributor to fatigue during follow-up.

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Ethics Approval

Immune Thrombocytopenia, Eltrombopag, Iron Deficiency, Ferritin, Fatigue

Supporting Agencies

None
Ahmet Yigitbasi, Trakya University Department of Hematology, Edirne/Türkiye

Trakya University Faculty of Medicine, Department of Hematology, Edirne/Türkiye.

Hematology Specialist, MD

Elif Gulsum Umit, Trakya University Department of Hematology, Edirne/Türkiye

Trakya University Faculty of Medicine, Department of Hematology. Professor of Hematology

Ufuk Demirci, Manisa Celal Bayar University Faculty of Medicine, Department of Hematology.

Manisa Celal Bayar University Faculty of Medicine, Department of Hematology. Hematologist, Doctor Lecturer.

Guray Aygun, Trakya University Department of Hematology, Edirne/Türkiye

Trakya University Faculty of Medicine, Department of Hematology, Edirne/Türkiye

Hematology fellow

Nese Varli, University of Health Sciences Hamidiye Faculty of Medicine, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Internal Medicine. Istanbul, Türkiye

University of Health Sciences Hamidiye Faculty of Medicine, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Internal Medicine. Istanbul, Türkiye

Internal Medicine Resident

Elif Aksoy, Kirklareli Training and Research Hospital, Hematology Clinic. Kirklareli, Türkiye

Kirklareli Training and Research Hospital, Hematology Clinic. Kirklareli, Türkiye

Hematology Specialist

Fehmi Hindilerden, University of Health Sciences Hamidiye Faculty of Medicine, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Hematology. Istanbul, Türkiye.

University of Health Sciences Hamidiye Faculty of Medicine, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Hematology. Istanbul, Türkiye. 

Emine Gulturk, University of Health Sciences Hamidiye Faculty of Medicine, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Hematology.

University of Health Sciences Hamidiye Faculty of Medicine, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Hematology. Istanbul, Türkiye.

Associate Professor

Eren Arslan Davulcu, University of Health Sciences Hamidiye Faculty of Medicine, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Hematology. Istanbul, Türkiye

University of Health Sciences Hamidiye Faculty of Medicine, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Hematology. M.D

Ahmet Muzaffer Demir, Trakya University Faculty of Medicine, Department of Hematology. Edirne, Türkiye.

Trakya University Faculty of Medicine, Department of Hematology. Professor of Hematology and Head of Department

How to Cite



“CLINICAL IMPACT OF ELTROMBOPAG-ASSOCIATED IRON CHELATION IN ADULTS WITH IMMUNE THROMBOCYTOPENIA: A MULTICENTER REAL-WORLD STUDY” (2026) Mediterranean Journal of Hematology and Infectious Diseases, 18(1). doi:10.4084/MJHID.2026.027.
Copyright (c) 2026 Ahmet Yigitbasi, Elif Gulsum Umit, Ufuk Demirci, Guray Aygun, Nese Varli, Elif Aksoy, Fehmi Hindilerden, Emine Gulturk, Eren Arslan Davulcu, Ahmet Muzaffer Demir Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.