Background: Immune thrombocytopenia is an immune-related disorder that causes an impairment in platelet production and stimulates platelet destruction, causing variable bleeding symptoms. Objective: This study focuses on refractory immune thrombocytopenic purpura patients on romiplostim treatment and their level of illness perception related to treatment response. Method: A cross-sectional study was conducted from May 1st, 2025, to August 1st, 2025. Brief Illness Perception Questionnaires were administered to 84 patients with ITP to collect the data. The study took place at the Hematology and Bone Marrow Transplant Center, Medical City, Baghdad, Iraq. Results: The romiplostim response rate is 21 (25.0%), while the partial response rate is 41 (48.8%). The most frequent complaints were bleeding, 46 (54.8%), and joint pain, 30 (35.7%). In terms of illness perceptions, treatment control had the greatest mean score (6.9±2.85), and understanding had the lowest mean score (4.2±4.6). Conclusions: Romiplostim showed effective management among Iraqi patients, and the patients believe in its effectiveness. A low level of patient understanding was shown among the participants; education programs and patient counseling are required to increase health literacy among patients with immune thrombocytopenic purpura.