Primary immune thrombocytopenia (ITP) is a rare autoimmune disease characterized by low platelet counts (12 months) . Thisupdate in the clinical definition of ITP has posed a number of challenges in terms of treatment decisions as initial drug indications, and associated clinical trial data were based on the old definition. Current guideline recommendations include corticosteroids, intravenous immunoglobulin (IVIg), or anti-D as firstline treatment options for newly diagnosed ITP, with romiplostim considered a second-line treatment option . Romiplostim is a thrombopoietin-receptor agonist (TPO-RA) that binds to the TPO receptor, activating the JAK2/ STAT5 pathway and ultimately leading to increased platelet production . Romiplostim has demonstrated sustained platelet responses together with low toxicity in patients with chronic ITP, with some patients experiencing treatmentfree responses. While romiplostim was initially approved for secondline treatment of chronic ITP in patients who are refractory to other treatments, such as corticosteroids, evidence from clinical and real- world studies indicated that it could also produce durable platelet responses in patients with newly diagnosed or persistent corticosteroid-refractory ITP