<prompt> Treatment of choice of severe ITP isBMTIV gammaglobulinsPlasmapheresisSteroids  <response>: Ans. b IV gamma globulin. Ref. Harrison, Principles of Medicine, 18thChapter 115.IDIOPATHIC THROMBOCYTOPENIC PURPURA Explosive onset of severe thrombocytopenia following recovery of viral exanthema or URI is common in children and accounts for 90 of paediatric immunologic thrombocytopenia. 90 recover in 3-6 months. Chronic ITP is common in females, 20-40 years of age. Treatment include- glucocorticoids- danazol,- IV Ig or anti-RhD.- Emergency splenectomy depending on response to medical line of treatment is recommended.- Anti CD 20 abs Rituximab is also being tried in treatment of ITP.Initial treatment in patients without significant bleeding symptoms, severe thrombocytopenia 5000L, or signs of impending bleeding such as retinal hemorrhage or large oral mucosal hemorrhages can be instituted as an outpatient using single agents. Traditionally, this has been prednisone at 1 mgkg, although Rh D immune globulin therapy WinRho SDF, at 50-75 gkg, is also being used in this setting.IVIgG has more efficacy than anti-Rh0D in postsplenectomized patients. IVIgG is dosed at 2 gkg total, given in divided doses over 2-5 days.For patients with severe ITP andor symptoms of bleeding, hospital admission and combined-modality therapy is given using high-dose glucocorticoids with IVIgG or anti-Rh D therapy, and, as needed, additional immunosuppressive agents. Rituximab, an anti-CD20 B cell antibody, has shown efficacy in the treatment of refractory ITP.Splenectomy has been used for treatment of patients who relapse after glucocorticoids are tapered.Thrombopoietin receptor agonists are now available for the treatment of ITP. Two agents, one administered subcutaneously romiplostim and another orally eltrombopag, have shown response in many patients with refractory ITP. 