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 (ITP)CHRONIC 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 and/or 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