One small retrospective study evaluated patients with ES who receive treatment with TPO-RAs and noted improvement in platelet counts; however, ES patients did have a greater relapse with the discontinuation of TPO-RAs and an increase in high-grade (grades 3 and 4) thrombotic adverse events when compared to patients with isolated ITP [9]. This evidence concerns the gene TPO and autoimmune thrombocytopenic purpura.