<prompt> A 5-year-old boy is brought in by his mother because of petechial bleeding and bruises on his torso and limbs. The child doesnt have any other signs or symptoms and doesnt appear to be ill. Mother reports gastrointestinal infection several weeks prior to petechiae and bruising. CBC shows thrombocytopenia 20xl09L. Other parameters of CBC are within expected range for age. Also, PT, PTT and metabolic panels are all within referent range. What is the expected outcome of this blood disorder?Complete resolution is expectedSurvival rate is up to 70 depending on risk stratificationLifelong disease dependent on factor VIII substitutionLifelong disease dependent on factor IX substitution  <response>: Answer: a Complete resolution is expectedDiagnosis appears to be UP. It usually follows viral infections in children aged 2 to 5 years and is of autoimmune origin. It is self-limiting in most cases and resolves completely in 6 weeks to 6 months in 80 of children.IMMUNE THROMBOCYTOPENIC PURPURA ITPCHRONIC ITP More common form Most common in adult women 40 yrs female-to-male ratio -3:1 Can be associated with connective tissue diseases, lymphoproliferative disease, medications and infections hepatitis C virus and HIV Auto-antibodies mostly IgG against platelet membrane glycoproteins llb-llla or Ib-IX Spleen is the major site of destruction of platelets Petechiae, ecchymosis, easy bruising, bleeding from nose and gums, menorrhagia Splenomegaly lymphadenopathy - rare Subarachnoid and intracerebral hemorrhage are rare but fatal complications Wet purpura blood blisters in the mouth Peripheral smear shows abnormally large platelets megathrombocytes low platelet count Bone marrow - hypercellular increased megakaryocytes Bleeding time prolonged PT and PTT are normalTreatment Initial treatment for patients without significant bleeding: Glucocorticoids Prednisone or Dexa - IV immunoglobulin or anti-D or anti-CD20 antibody rituximab Two-thirds of patients respond to initial treatment, but most people relapse following reduction of the corticosteroid dose Patients with severe ITP andor symptoms of bleeding: hospital admission and combined therapy high-dose glucocorticoids IVIgG or anti-RhO D therapy Relapse: Splenectomy Refractory cases: Thrombopoietin receptor agonists Romiplostim and eltrombopag or splenectomyACUTE ITP Disease of childhood Affects both sexes equally Onset is abrupt Many cases are preceded by viral illness The usual interval between the infection and onset of purpura is 2 weeks Self-limited, spontaneous resolution in 6 months 20 children those without viral prodrome have persistent low platelet counts after 6 months 