Background and Aims Adult immune thrombocytopenia (ITP) combined with hepatic hemangioma is clinically rare and prone to misdiagnosis and mistreatment. Here, the authors report the diagnosis and treatment process of a case of adult ITP combined with hepatic hemangioma, aiming to provide reference and insights for clinical practice.Methods A retrospective analysis of the clinical data of an adult patient with ITP and concomitant hepatic hemangioma admitted to the Second Affiliated Hospital of Guilin Medical College was conducted. The clinical features and treatment characteristics of the disease were summarized in conjunction with relevant literature.Results The patient, a 46-year-old female, was admitted to the Department of Hematology due to generalized skin and mucosal bleeding for over a month, and thrombocytopenia for 1 d. Blood cell analysis revealed a platelet count of 4.0×10⁹/L, normal coagulation function, and bone marrow aspiration biopsy suggested a relative increase in megakaryocytes with rare platelets. The diagnosis was highly suspicious of ITP. After treatment with steroids and other measures, the skin and mucosal bleeding improved, and the platelet count increased to 59×10⁹/L. Abdominal enhanced CT indicated a massive hemangioma on the right liver, and then, the patient was transferred to the Department of Hepatobiliary and Pancreatic Surgery for resection of the liver hemangioma. After operation, there was significant bleeding in the surgical area, vaginal bleeding, and a gradual decrease in platelets to 3.0×10⁹/L. The right pleural cavity accumulated a large amount of fluid, but coagulation function remained normal. After interventions including hemostasis, transfusion, immune modulation, anti-infection measures, and thoracic puncture drainage, the patient gradually recovered. On the 13th d after operation, the platelet count increased to 220×10⁹/L. Follow-up for 32 months revealed no recurrence of skin and mucosal bleeding, with the platelet count maintained within the normal range.Conclusion In adult ITP, vigilance is necessary for the presence of concomitant hepatic hemangioma. Treatment of the hemangioma can achieve favorable long-term outcomes, but meticulous perioperative management is essential for the uneventful recovery of patients.