The aim is to evaluate safety and efficacy of Romiplostim in the treatment of chronic ITP in children

Inclusion Criteria:

• Patients aged between 1 and 18 years
• Diagnosis of chronic ITP
• Refractory to or intolerant of first-line therapies (e.g.corticosteroids , intravenous immunoglobulin [ IVIG ] , and oral eltrombopag )
• Platelet count<30,000/µL, or evidence of bleeding or risk of bleeding with platelet count<50,000/µL.
• Written informed consent (or parental/guardian consent for minors)

Exclusion Criteria:

• Evidence of secondary thrombocytopenia (e.g., HIV, HCV, systemic lupus erythematosus)
• congenital thrombocytopenia
• Age < 1year or more than 18 years
• Aplastic anemia
• Known hypersensitivity to romiplostim or any of its components

The study will include pediatric patients aged 1 to 18 years with a diagnosis of chronic immune thrombocytopenia (ITP) who are refractory to or intolerant of first-line therapies (e.g., corticosteroids, intravenous immunoglobulin, or oral eltrombopag). Eligible patients must have a platelet count <30,000/µL, or evidence of bleeding/risk of bleeding with platelet count <50,000/µL. Patients with secondary or congenital thrombocytopenia, aplastic anemia, age <1 year or >18 years, or known hypersensitivity to romiplostim will be excluded. A total of 100 patients will be enrolled from the Pediatric Department at Assiut University Hospital.