High Cytomegalovirus Load Is Associated With More Severe CMV-Associated Thrombocytopenia: A 6-Year Study in Eastern China

Cytomegalovirus (CMV)-associated thrombocytopenia is a rare complication, and its prevalence, severity, and prognosis remain poorly characterized. Among 2927 children confirmed CMV infection, 87 (3%) had thrombocytopenia from July 2018 to April 2024. The clinical characteristics of CMV-associated thrombocytopenia were described, according to CMV-DNA load. Logistic regression was used to compare the risk factors for organ hemorrhage. In this prospective cohort of CMV-associated thrombocytopenia, most children were infants with onset age at 53 (24.0–90.3) days. Among them, 78.2% exhibited bleeding manifestations, 16.1% experienced organ hemorrhage, 51.7% had severe thrombocytopenia, and 5.7% died. Interestingly, low platelet count (≤ 20 × 10⁹/L) was not a high-risk factor (OR, 3.89 [95% CI, 0.59–42.37]) for organ hemorrhage. However, patients in the high CMV-DNA load group had a 3.61 times higher risk of organ hemorrhage (OR, 3.61 [95% CI, 1.03–12.65]), which remained significant in subgroup analyses according to shorter activated partial thromboplastin time (OR, 5.16 [95% CI, 1.16–22.89]). In conclusion, CMV infection may lead to significant thrombocytopenia, which result in severe organ hemorrhage particularly in infants. High CMV-DNA load contributes to the severity of the condition.