Long-term PM2.5 pollution over China: Identification of PM2.5 pollution hotspots and source contributions.

Fine particulate matter, with an aerodynamic diameter ≤ 2.5 µm (PM2.5), is a severe problem in China. The lack of ground-based measurements and its sparse distribution obstruct long-term air pollution impact studies over China. Therefore, the present study used newly updated Global Estimates (V5. GL.02) of monthly PM2.5 data from 2001 to 2020 based on Geographically Weighted Regression (GWR) by Washington University. The GWR PM2.5 data were validated against ground-based measurements from 2014 to 2020, and the validation results demonstrated a good agreement between GWR and ground-based PM2.5 with a higher correlation (r = 0.95), lower error (8.14), and lower bias (-3.10 %). The long-term (2001-2020) PM2.5 data were used to identify pollution hotspots and sources across China using the potential source contribution function (PSCF). The results showed highly significant PM2.5 pollution hotspots in central (Henan, Hubei), North China Plain (NCP), northwest (Taklimakan), and Sichuan Basin (Chongqing, Sichuan) in China, with the most severe pollution occurring in winter compared to other seasons. During the winter, PM2.5 was in the range from 6.08 to 93.05 µg/m3 in 33 provinces, which is 1.22 to 18.61 times higher than the World Health Organization (WHO) Air Quality Guidelines (AQG-2021; annual mean: 5 µg/m3). In 26 provinces, the reported PM2.5 was 1.07 to 2.66 times higher than the Chinese Ambient Air Quality Standard (AAQS; annual mean: 35 µg/m3). Furthermore, provincial-level trend analysis shows that in most Chinese provinces, PM2.5 increased significantly (3-43 %) from 2001 to 2012, whereas it decreased by 12-94 % from 2013 to 2020 due to the implementation of air pollution control policies. Finally, the PSCF analysis demonstrates that China's air quality is mainly affected by local PM2.5 sources rather than by pollutants imported from outside China.

Comment on Abdul Jabbar et al. Air Quality, Pollution and Sustainability Trends in South Asia: A Population-Based Study. Int. J. Environ. Res. Public Health 2022, 19, 7534.

This comment discusses the use of PM2.5 (mass concentration of fine particulate matter with an aerodynamic diameter less than 2.5 microns) data in the recently published article entitled "Air Quality, Pollution and Sustainability Trends in South Asia: A Population-Based Study" by Abdul Jabbar et al. [...].

Monitoring the Sea Surface Microlayer (SML) on Sentinel images.

Slicks on the sea surface are usually related to oil spills, algal blooms or organic runoff around coastlines. An extensive network of slicks extending across the English Channel is seen on Sentinel 1 and Sentinel 2 images and are identified as comprising a film of natural surfactant material within the sea surface microlayer (SML). As the SML represents the interface between ocean and atmosphere, controlling the vital exchange of gases and aerosols, identification of the slicks on images can add a new dimension to climate modelling. Current models use primary productivity often combined with wind speed, but quantifying the global extent of surface films spatially and temporally is difficult due to their patchy nature. The slicks are shown to be visible on Sentinel 2 optical images affected by sun glint, due to the wave dampening effect of the surfactants. On a Sentinel 1 SAR image of the same day, they can be identified using the VV polarised band. The paper investigates the nature and spectral properties of the slicks in relation to sun glint, and evaluates the performance of chlorophyll-a, floating algae and floating debris indices on the slick-affected areas. No index was able to distinguish slicks from non-slick areas as successfully as the original sun glint image. This image was used to devise a tentative Surfactant Index (SI) which indicates over 40 % of the study area covered by slicks. As ocean sensors have lower spatial resolution and are generally designed to avoid sun glint, Sentinel 1 SAR may offer a useful alternative for monitoring the global spatial extent of surface films, until dedicated sensors and algorithms can be developed.

Spatiotemporal changes in aerosols over Bangladesh using 18 years of MODIS and reanalysis data.

In this study, combined Dark Target and Deep Blue (DTB) aerosol optical depth at 550 nm (AOD550 nm) data the Moderate Resolution Imaging Spectroradiometer (MODIS) flying on the Terra and Aqua satellites during the years 2003-2020 are used as a reference to assess the performance of the Copernicus Atmosphere Monitoring Services (CAMS) and the second version of Modern-Era Retrospective analysis for Research and Applications (MERRA-2) AOD over Bangladesh. The study also investigates long-term spatiotemporal variations and trends in AOD, and determines the relative contributions from different aerosol species (black carbon: BC, dust, organic carbon: OC, sea salt: SS, and sulfate) and anthropogenic emissions to the total AOD. As the evaluations suggest higher accuracy for CAMS than for MERRA-2, CAMS is used for further analysis of AOD over Bangladesh. The annual mean AOD from both CAMS and MODIS DTB is high (>0.60) over most parts of Bangladesh except for the eastern areas of Chattogram and Sylhet. Higher AOD is observed in spring and winter than in summer and autumn, which is mainly due to higher local anthropogenic emissions during the winter to spring season. Annual trends from 2003-2020 show a significant increase in AOD (by 0.006-0.014 year-1) over Bangladesh, and this increase in AOD was more evident in winter and spring than in summer and autumn. The increasing total AOD is caused by rising anthropogenic emissions and accompanied by changes in aerosol species (with increased OC, sulfate, and BC). Overall, this study improves understanding of aerosol pollution in Bangladesh and can be considered as a supportive document for Bangladesh to improve air quality by reducing anthropogenic emissions.

Trends in vegetation productivity related to climate change in China's Pearl River Delta.

Climate change will be a powerful stressor on ecosystems and biodiversity in the second half of the 21st century. In this study, we used the satellite-derived Normalized Difference Vegetation Index (NDVI) to examine a 34-year trend along with the response of vegetation to climate indicators surrounding the world's largest megacity: the Pearl River Delta (PRD) of China. An overall increasing trend is observed in vegetation productivity metrics over the study period 1982 to 2015. Increase in winter productivity in both natural ecosystems and croplands is more related to increasing temperatures (r = 0.5-0.78), than to changes in rainfall. For growing season productivity, negative correlations with temperature were observed in cropland regions, and some forests in the northern part of PRD region, suggesting high-temperature stress on crop production and forest vegetation. However, increased winter and spring temperatures provide higher opportunities for cropping in winter. During the decade 1995-2004, vegetation productivity metrics showed a reversal in the upward trend. The geographical and biological complexity of the region under significant climatic and development impacts suggests causative factors would be synergistic. These include our observed decrease in sunshine hours, increasing cloud cover associated with atmospheric aerosols from industrial and urban development, direct pollution effects on plant growth, and exceedance of high temperature growth thresholds.

Spatial analysis of the impact of urban geometry and socio-demographic characteristics on COVID-19, a study in Hong Kong.

The World Health Organization considered the wide spread of COVID-19 over the world as a pandemic. There is still a lack of understanding of its origin, transmission, and treatment methods. Understanding the influencing factors of COVID-19 can help mitigate its spread, but little research on the spatial factors has been conducted. Therefore, this study explores the effects of urban geometry and socio-demographic factors on the COVID-19 cases in Hong Kong. For each patient, the places they visited during the incubation period before going to hospital were identified, and matched with corresponding attributes of urban geometry (i.e., building geometry, road network and greenspace) and socio-demographic factors (i.e., demographic, educational, economic, household and housing characteristics) based on the coordinates. The local cases were then compared with the imported cases using stepwise logistic regression, logistic regression with case-control of time, and least absolute shrinkage and selection operator regression to identify factors influencing local disease transmission. Results show that the building geometry, road network and certain socio-economic characteristics are significantly associated with COVID-19 cases. In addition, the results indicate that urban geometry is playing a more important role than socio-demographic characteristics in affecting COVID-19 incidence. These findings provide a useful reference to the government and the general public as to the spatial vulnerability of COVID-19 transmission and to take appropriate preventive measures in high-risk areas.

Spatial and environmental constraints on natural forest regeneration in the degraded landscape of Hong Kong.

Tropical forests are the main reservoirs for global biodiversity and climate control. As secondary forests are now more widespread than primary forests, understanding their functioning and role in the biosphere is increasingly important. This includes understanding how they achieve stability, how they accumulate species and build biodiversity and how they cycle nutrients and carbon. This study investigates how we can restore tropical secondary forests to resemble high biomass, highly biodiverse and stable ecosystems seen today only in primary, undisturbed forests. The study used historic aerial photographs and recent high-resolution satellite images from 1945 to 2014 to map forest patches with five age categories, from 14-years to over 70-years, in Hong Kong's degraded tropical landscape. A forest inventory comprising 28 quadrats provided a rare opportunity to relate patterns of species composition at different stages during the succession with topographic and soil characteristics. The topographic variables accounted for 15% of the variance in species abundance, and age of forest stands explained 29%. Species richness rapidly increased after the first 15 years, but was lower in old-growth, than in medium age forest. This is attributed to the inability of late-successional species to disperse into the young forests as the natural dispersal agents (birds, mammals) have been lost. Light-loving pioneers which are unable to tolerate the shade of older forests, cannot regenerate in their own shade, therefore species diversity declines after a few decades. For ecosystem restoration in tropical secondary forests, introduction of late-successional species is necessary to assist natural succession, given the absence of native fauna, seed dispersal agents, and the surrounding altered environment. We also show that remote sensing can play a pivotal role in understanding the recovery and functioning of secondary forest regeneration as its contribution to the biosphere is increasingly important.

A new approach for the estimation of phytoplankton cell counts associated with algal blooms.

This study proposes a method for estimating phytoplankton cell counts associated with an algal bloom, using satellite images coincident with in situ and meteorological parameters. Satellite images from Landsat Thematic Mapper (TM), Enhanced Thematic Mapper Plus (ETM+), Operational Land Imager (OLI) and HJ-1 A/B Charge Couple Device (CCD) sensors were integrated with the meteorological observations to provide an estimate of phytoplankton cell counts. All images were atmospherically corrected using the Second Simulation of the Satellite Signal in the Solar Spectrum (6S) atmospheric correction method with a possible error of 1.2%, 2.6%, 1.4% and 2.3% for blue (450-520nm), green (520-600nm), red (630-690nm) and near infrared (NIR 760-900nm) wavelengths, respectively. Results showed that the developed Artificial Neural Network (ANN) model yields a correlation coefficient (R) of 0.95 with the in situ validation data with Sum of Squared Error (SSE) of 0.34cell/ml, Mean Relative Error (MRE) of 0.154cells/ml and a bias of -504.87. The integration of the meteorological parameters with remote sensing observations provided a promising estimation of the algal scum as compared to previous studies. The applicability of the ANN model was tested over Hong Kong as well as over Lake Kasumigaura, Japan and Lake Okeechobee, Florida USA, where algal blooms were also reported. Further, a 40-year (1975-2014) red tide occurrence map was developed and revealed that the eastern and southern waters of Hong Kong are more vulnerable to red tides. Over the 40 years, 66% of red tide incidents were associated with the Dinoflagellates group, while the remainder were associated with the Diatom group (14%) and several other minor groups (20%). The developed technology can be applied to other similar environments in an efficient and cost-saving manner.

A 70-year perspective on tropical forest regeneration.

Forested areas of the world decreased by 129 million hectare during the past quarter-century, and only 35 % of remainder is primary forest. Secondary forests are therefore relatively more important for biodiversity conservation, catchment protection, climate control, and the ecological services they provide. Many governments expend large resources on afforestation projects, which may not be supported by objective data on rates and pathways of natural succession in secondary forest. This paper describes a 70-year succession of tropical forest in Hong Kong under different management regimes including afforestation programs, frequent fire, and fire protection. From complete destruction of its forest during the Second World War, forest has established rapidly in areas where a shrub cover was able to colonize. The practice of afforestation as a nursery stage on degraded hillsides, for establishment of forest seedlings by natural invasion is not supported by the evidence, as when the native Pinus massoniana plantations were eliminated by disease during the 1970s, no forest or woody species were seen in the areas affected. In fact there was a reversion to grassland, which persisted there for almost three decades, until recent shrub invasion. The fastest period of forest regeneration, at 10.9% annually between 1989 and 2001, occurred when shrubland edge was greatest and forest was able to colonize across interfluves between linear-shaped riparian shrublands in valley bottoms. After 2001, succession to forest was slower, at 7.8% annually, as forest patches consolidated and edge habitats reduced. Effective forest management policies could include seeding of native shrubs extending linearly from established forest, to maximize edge length between woody species and grasslands, and planting of late successional species in areas where forest pioneers are in decline.

Integration of remote sensing datasets for local scale assessment and prediction of drought.

Recent attempts to integrate remote sensing-based drought indices with precipitation data seem promising, and can compensate for potential uncertainties from image-based parameters alone, which may be unrelated to meteorological drought. However most remote sensing-based studies have been at regional or global scale and have not considered differences between different land cover types. This study examines a drought-prone region in Central Yunnan Province of China over a four-year period including a notable severe drought event in 2010. The study investigates the phase relationships between meteorological drought from image-based rainfall estimates from the Tropical Rainfall Measurement Mission (TRMM), and imaged drought from a remote sensing drought index, the Normalised Vegetation Supply Water Index (NVSWI) for different land cover types at local scale. The land cover types derived from MODIS and Landsat images were resampled to 250 m to match all datasets used. Significant differences between cover types are observed, with cropland and shrubland most highly correlated with 64 days' earlier rainfall and evergreen forest most responsive to rainfall 90 days earlier, indicating a need to consider detailed land cover information for accurate integrated drought indices. The finding that concurrent rainfall is only weakly correlated with observed drought, suggests that existing drought indices, which compute lowest weightings for the most distant lag period would be unrepresentative.

Estimating surface visibility at Hong Kong from ground-based LIDAR, sun photometer and operational MODIS products.

Hong Kong's surface visibility has decreased in recent years due to air pollution from rapid social and economic development in the region. In addition to deteriorating health standards, reduced visibility disrupts routine civil and public operations, most notably transportation and aviation. Regional estimates of visibility solved operationally using available ground and satellite-based estimates of aerosol optical properties and vertical distribution may prove more effective than standard reliance on a few existing surface visibility monitoring stations. Previous studies have demonstrated that such satellite measurements correlate well with near-surface optical properties, despite these sensors do not consider range-resolved information and indirect parameterizations necessary to solve relevant parameters. By expanding such analysis to include vertically resolved aerosol profile information from an autonomous ground-based lidar instrument, this work develops six models for automated assessment of surface visibility. Regional visibility is estimated using co-incident ground-based lidar, sun photometer visibility meter and MODerate-resolution maging Spectroradiometer (MODIS) aerosol optical depth data sets. Using a 355 nm extinction coefficient profile solved from the lidar MODIS AOD (aerosol optical depth) is scaled down to the surface to generate a regional composite depiction of surface visibility. These results demonstrate the potential for applying passive satellite depictions of broad-scale aerosol optical properties together with a ground-based surface lidar and zenith-viewing sun photometer for improving quantitative assessments of visibility in a city such as Hong Kong.

Urban temperatures in Hong Kong: thermal environmental safety and implications for city planning.

Cutaneous thermal injury caused by direct contact with objects heated solely by sun exposure is rare. We undertook to investigate factors that may influence the temperature of sun-exposed objects at the ground level. Two clinical cases of burns caused by contact with sun-exposed objects are described. Surface temperatures on a citywide scale were determined from satellite thermal images. Ground level surface temperatures of a variety of objects were measured using an infrared thermometer. The satellite thermal image demonstrated local surface temperature differences (of more than 10.6 degrees C variation) and the temperature at the places of study (8.5-9.5 degrees C above background). Infrared thermometer readings demonstrated that the surface temperature of a sun-exposed black car could be as high as 75.0 degrees C (range, 71-78 degrees C) compared with 44.6 degrees C (42.2-47.3 degrees C) for a white car, and shading significantly reduced the surface temperatures of exposed objects (10.4-48.1%). The risk of injury is related to the effects of city planning on urban temperatures, of material color, composition, and shade on the ground level temperatures, and to the rise in global temperatures because of greenhouse-induced warming. The combined effect means that in a modern subtropical city such as Hong Kong, a substantial percentage of the urban area may have summertime surface temperatures that are high enough to constitute a health hazard. We recommend that this potential cause of harm to health be taken into account during urban planning.

Pathogenesis of chronic immune thrombocytopenia: increased platelet destruction and/or decreased platelet production.

Chronic immune thrombocytopenia (ITP) is a haematological disorder in which patients predominantly develop skin and mucosal bleeding. Early studies suggested ITP was primarily due to immune-mediated peripheral platelet destruction. However, increasing evidence indicates that an additional component of this disorder is immune-mediated decreased platelet production that cannot keep pace with platelet destruction. Evidence for increased platelet destruction is thrombocytopenia following ITP plasma infusions in normal subjects, in vitro platelet phagocytosis, and decreased platelet survivals in ITP patients that respond to therapies that prevent in vivo platelet phagocytosis; e.g., intravenous immunoglobulin G, anti-D, corticosteroids, and splenectomy. The cause of platelet destruction in most ITP patients appears to be autoantibody-mediated. However, cytotoxic T lymphocyte-mediated platelet (and possibly megakaryocyte) lysis, may also be important. Studies supporting suppressed platelet production include: reduced platelet turnover in over 80% of ITP patients, morphological evidence of megakaryocyte damage, autoantibody-induced suppression of in vitro megakaryocytopoiesis, and increased platelet counts in most ITP patients following treatment with thrombopoietin receptor agonists. This review summarizes data that indicates that the pathogenesis of chronic ITP may be due to both immune-mediated platelet destruction and/or suppressed platelet production. The relative importance of these two mechanisms undoubtedly varies among patients.

Safety and efficacy of long-term treatment with romiplostim in thrombocytopenic patients with chronic ITP.

Chronic immune thrombocytopenic purpura (ITP) is characterized by low platelet counts and mucocutaneous bleeding. In previous studies romiplostim (AMG531), a thrombopoiesis-stimulating protein, increased platelet counts in most patients with chronic ITP. This ongoing, long-term open-label, single-arm study investigated safety and efficacy in patients who completed a previous romiplostim study and had platelet counts less than or equal to 50 [corrected] x 10(9)/L. One hundred forty-two patients were treated for up to 156 weeks (mean, 69 weeks). Platelet responses (platelet count > or = 50 x 10(9)/L and double baseline) were observed in 87% of all patients and occurred on average 67% of the time in responding patients. In 77% of patients, the romiplostim dose remained within 2 microg/kg of their most frequent dose at least 90% of the time. Ninety patients (63%) received treatment by self-administration. Treatment-related serious adverse events were reported in 13 patients (9%). Bone marrow reticulin was observed in 8 patients; marrows were not routinely performed in this study, so the true incidence of this event cannot be determined. Severe bleeding events were reported in 12 patients (9%). Thrombotic events occurred in 7 patients (5%). In conclusion, romiplostim increased platelet counts in most patients for up to 156 weeks without tachyphylaxis and had an acceptable safety profile. (ClinicalTrials.gov Identifier NCT00116688).

Modeling of Aerosol Vertical Profiles Using GIS and Remote Sensing.

The use of Geographic Information Systems (GIS) and Remote Sensing (RS) by climatologists, environmentalists and urban planners for three dimensional modeling and visualization of the landscape is well established. However no previous study has implemented these techniques for 3D modeling of atmospheric aerosols because air quality data is traditionally measured at ground points, or from satellite images, with no vertical dimension. This study presents a prototype for modeling and visualizing aerosol vertical profiles over a 3D urban landscape in Hong Kong. The method uses a newly developed technique for the derivation of aerosol vertical profiles from AERONET sunphotometer measurements and surface visibility data, and links these to a 3D urban model. This permits automated modeling and visualization of aerosol concentrations at different atmospheric levels over the urban landscape in near-real time. Since the GIS platform permits presentation of the aerosol vertical distribution in 3D, it can be related to the built environment of the city. Examples are given of the applications of the model, including diagnosis of the relative contribution of vehicle emissions to pollution levels in the city, based on increased near-surface concentrations around weekday rush-hour times. The ability to model changes in air quality and visibility from ground level to the top of tall buildings is also demonstrated, and this has implications for energy use and environmental policies for the tall mega-cities of the future.

High resolution remote sensing of densely urbanised regions: a case study of Hong Kong.

Data on the urban environment such as climate or air quality is usually collected at a few point monitoring stations distributed over a city. However, the synoptic viewpoint of satellites where a whole city is visible on a single image permits the collection of spatially comprehensive data at city-wide scale. In spite of rapid developments in remote sensing systems, deficiencies in image resolution and algorithm development still exist for applications such as air quality monitoring and urban heat island analysis. This paper describes state-of-the-art techniques for enhancing and maximising the spatial detail available from satellite images, and demonstrates their applications to the densely urbanised environment of Hong Kong. An Emissivity Modulation technique for spatial enhancement of thermal satellite images permits modelling of urban microclimate in combination with other urban structural parameters at local scale. For air quality monitoring, a Minimum Reflectance Technique (MRT) has been developed for MODIS 500 m images. The techniques described can promote the routine utilization of remotely sensed images for environmental monitoring in cities of the 21(st) century.

Impact of chronic Immune Thrombocytopenic Purpura (ITP) on health-related quality of life: a conceptual model starting with the patient perspective.

BACKGROUND: Immune thrombocytopenic purpura (ITP), a condition characterized by autoimmune-mediated platelet destruction and suboptimal platelet production, is associated with symptoms such as bruising, epistaxis, menorrhagia, mucosal bleeding from the gastrointestinal and urinary tracts and, rarely central nervous system bleeding. The aim of this research is to develop a conceptual model to describe the impact of ITP and its treatment on patients' health-related quality of life (HRQoL). METHODS: A literature search and focus groups with adult ITP patients were conducted to identify areas of HRQoL affected by ITP. Published literature was reviewed to identify key HRQoL issues and existing questionnaires used to assess HRQoL. Focus group transcripts were reviewed, and common themes were extracted by grouping conceptual categories that described the impact on HRQoL. RESULTS: The literature synthesis and themes from the focus group data suggest that decreased platelet counts, disease symptoms, and treatment side effects influence multiple domains of HRQoL for ITP patients. Key areas affected by ITP and its treatments include emotional and functional health, work life, social and leisure activities, and reproductive health. CONCLUSION: ITP affects various areas of HRQoL. This conceptual model will help inform the evaluation of therapeutic strategies for ITP.

Efficacy of romiplostim in patients with chronic immune thrombocytopenic purpura: a double-blind randomised controlled trial.

BACKGROUND: Chronic immune thrombocytopenic purpura (ITP) is characterised by accelerated platelet destruction and decreased platelet production. Short-term administration of the thrombopoiesis-stimulating protein, romiplostim, has been shown to increase platelet counts in most patients with chronic ITP. We assessed the long-term administration of romiplostim in splenectomised and non-splenectomised patients with ITP. METHODS: In two parallel trials, 63 splenectomised and 62 non-splenectomised patients with ITP and a mean of three platelet counts 30x10(9)/L or less were randomly assigned 2:1 to subcutaneous injections of romiplostim (n=42 in splenectomised study and n=41 in non-splenectomised study) or placebo (n=21 in both studies) every week for 24 weeks. Doses of study drug were adjusted to maintain platelet counts of 50x10(9)/L to 200x10(9)/L. The primary objectives were to assess the efficacy of romiplostim as measured by a durable platelet response (platelet count > or =50x10(9)/L during 6 or more of the last 8 weeks of treatment) and treatment safety. Analysis was per protocol. These studies are registered with ClinicalTrials.gov, numbers NCT00102323 and NCT00102336. FINDINGS: A durable platelet response was achieved by 16 of 42 splenectomised patients given romplostim versus none of 21 given placebo (difference in proportion of patients responding 38% [95% CI 23.4-52.8], p=0.0013), and by 25 of 41 non-splenectomised patients given romplostim versus one of 21 given placebo (56% [38.7-73.7], p<0.0001). The overall platelet response rate (either durable or transient platelet response) was noted in 88% (36/41) of non-splenectomised and 79% (33/42) of splenectomised patients given romiplostim compared with 14% (three of 21) of non-splenectomised and no splenectomised patients given placebo (p<0.0001). Patients given romiplostim achieved platelet counts of 50x10(9)/L or more on a mean of 13.8 (SE 0.9) weeks (mean 12.3 [1.2] weeks in splenectomised group vs 15.2 [1.2] weeks in non-splenectomised group) compared with 0.8 (0.4) weeks for those given placebo (0.2 [0.1] weeks vs 1.3 [0.8] weeks). 87% (20/23) of patients given romiplostim (12/12 splenectomised and eight of 11 non-splenectomised patients) reduced or discontinued concurrent therapy compared with 38% (six of 16) of those given placebo (one of six splenectomised and five of ten non-splenectomised patients). Adverse events were much the same in patients given romiplostim and placebo. No antibodies against romiplostim or thrombopoietin were detected. INTERPRETATION: Romiplostim was well tolerated, and increased and maintained platelet counts in splenectomised and non-splenectomised patients with ITP. Many patients were able to reduce or discontinue other ITP medications. Stimulation of platelet production by romiplostim may provide a new therapeutic option for patients with ITP.