If patients do not respond to the first-line therapy, or if continuous therapy is needed, the disorder is called refractory ITP, and second-line therapy is indicated: Rituximab, high-dose dexamethasone, thrombopoietin receptor agonists, splenectomy, or cytotoxic drugs represent second line therapies for refractory ITP (14). The gene discussed is MPL; the disease is autoimmune thrombocytopenic purpura.