Long Non-Coding RNAs in Immune Thrombocytopenia: A Narrative Review of Pathogenesis and Potential Clinical Implications

Background/Objectives: Immune thrombocytopenia (ITP) involves immune-mediated platelet destruction and impaired platelet production. Long non-coding RNAs (lncRNAs) regulate immune responses, but their clinical relevance in ITP remains uncertain. This narrative review examines disease-associated expression and mechanistic findings, distinguishing translational potential from established clinical utility. Methods: English-language literature identified through PubMed, Scopus, and Google Scholar was synthesized narratively. Eight named lncRNAs were prioritized because the cited ITP studies provided transcript-specific patient data or functional evidence; exploratory expression profiling and evidence from other diseases were considered separately. Study design, sample size, specimen type, treatment exposure, and validation status informed interpretation. Results: The selected transcripts were HCP5, NEAT1, lnc-DC, IFNG-AS1, MEG3, GAS5, MALAT1, and THRIL. Among the clinical studies with reported sample sizes, ITP groups generally included 20–90 patients, except for a GAS5 polymorphism study involving 302 patients. An independent prognostic association for low HCP5 expression was reported in a single study of 40 patients and has not been externally validated. Other studies described exploratory associations with bleeding, disease duration, or treatment response. Distinguishing primary from secondary ITP and selecting patients for splenectomy are not established applications. Cell experiments and a mouse model support mechanistic hypotheses but do not demonstrate therapeutic efficacy in humans. Conclusions: The evidence supports biological plausibility and translational investigation, rather than routine diagnostic, prognostic, or treatment-guiding use. Prospective validation in clinically representative cohorts and standardized assays are required.