Immune thrombocytopenia (ITP) is an autoimmune hematologic disorder that arises from an imbalance in immune responses, disrupting the delicate equilibrium of the immune system. An increasing body of research has indicated that immune-related genes hold promise as biomarkers for diagnosis and prognosis, with a particular focus on the roles of B and T cells in ITP pathogenesis. Despite these advancements, a deeper understanding of the underlying regulatory mechanisms governing these immune-related genes remains essential. This review aims to integrate the current body of evidence and provide further insights into the epigenetic regulation of immune pathways involved in ITP development. The problem statement section highlights the complexity of ITP and its intricate connections with immune pathways. It also compares the epigenetic differences between pediatric and adult ITP based on existing evidence. Decoding epigenetic processes could potentially open up new avenues for improving diagnostic methods and therapeutic strategies for ITP.