azathioprine + rituximab + romiplostim

This is a combination therapy using three different medications with complementary mechanisms of action for treating immune thrombocytopenia (ITP): - **Azathioprine**: An immunosuppressive drug that has been widely used for autoimmune diseases for over 50 years - **Rituximab**: A monoclonal antibody that depletes B cells, reducing platelet antibody levels - **Romiplostim (Nplate)**: A thrombopoietin receptor agonist (TPO-RA) that stimulates platelet production by binding to thrombopoietin receptors on megakaryocyte precursors This combination approach targets multiple aspects of ITP pathophysiology: azathioprine provides broad immunosuppression, rituximab specifically targets B cells responsible for producing antiplatelet antibodies, and romiplostim directly stimulates platelet production to counteract destruction.