Abstract: Objective To analyze the clinical characteristics, therapeutic effect and prognosis of primary immune thrombocytopenia (ITP) in the elderly. Methods The clinical data of 115 elderly patients with ITP hospitalized in our department of hematology from January 2013 to October 2017 were retrospectively analyzed, who were over 60 years old. The clinical characteristics of all patients with ITP were recorded, including bleeding score, treatment method and treatment effect. Bone marrow image and Th1/Th2 cytokine expression, secondary infection and other complications as well as prognosis. Statistical analysis were conducted by SPSS 17.0. Results There were 52 males and 63 females in 115 elderly patients over 60 years with ITP. The median age was 67 years old, ranging from 60 to 91. Of 115 elderly ITP patients, with the increase in age, the higher would be the risk of bleeding, and so did the proportion of severe bleeding patients. In elderly patients with ITP, IFN-γ and IL-10 were significantly decreased, and other indicators such as TNF-α, IL-2, IL-4 and IL-5 were significantly increased (P<0.05). The therapeutic effects were decreased with increased age or delayed course. The treatment effective rate of 60-69 years old group was the highest (86.9%). The elderly ITP patients easily suffered from infections during the use of glucocorticoid (22.1%), and the most common was pulmonary fungus infection. Six patients died (5.2%): four died of pulmonary infection, only one of intracranial hemorrhage. Conclusion Elderly ITP patients were more severe. With increasing age and duration of the disease, the patient's treatment efficiency is lower. There is disturbance of immune balance of Th1/Th2 in elderly ITP patients. Patients have a higher incidence of infections and becomes the cause of death during the use of glucocorticoids. The choice of treatment needs to balance advantages and disadvantages.