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While ITP has been characterized as an acquired disorder of the adaptive immune system, the resulting platelet autoantibodies provide ancillary links to the innate immune system via antibody interaction with the complement system. Most autoantibodies in patients with ITP are of the IgG1 subclass, which can be potent activators of the classical complement pathway. Antibody\u2010coated platelets can initiate complement activation via the classical pathway leading to both direct platelet destruction and enhanced clearance of C3b\u2010coated platelets by complement receptors. Similar autoantibody interactions with bone marrow megakaryocytes can also result in complement injury and ineffective thrombopoiesis. The development of novel therapeutic complement inhibitors has revived interest in the role of complement in autoantibody\u2010mediated disorders, such as ITP. A recent early\u2010phase clinical trial of a classical complement pathway inhibitor has demonstrated efficacy in a subset of ITP patients refractory to conventional immune modulation. In this review, we will analyse the role of complement in refractory ITP.<\/jats:p>","DOI":"10.1111\/bjh.19070","type":"journal-article","created":{"date-parts":[[2023,9,22]],"date-time":"2023-09-22T03:20:29Z","timestamp":1695352829000},"page":"96-100","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Complement in immune thrombocytopenia (ITP): The role of complement in refractory ITP"],"prefix":"10.1111","volume":"203","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8906-1552","authenticated-orcid":false,"given":"Ilene Ceil","family":"Weitz","sequence":"first","affiliation":[{"name":"Jane Anne Nohl Division of Hematology University of Southern California\u2010Keck School of Medicine  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5865-5104","authenticated-orcid":false,"given":"Howard 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