INTRODUCTION Idiopathic thrombocytopenic purpura (ITP) is the condition of having an abnormally low platelet count (thrombocytopenia) of unknown cause

(idiopathic). As most incidents of ITP appear to be related to the production of antibodies against platelets, immune thrombocytopenic purpura or immune thrombocytopenia are terms also used to describe this condition. Often ITP is asymptomatic (devoid of obvious symptoms) and can be discovered incidentally, but a very low platelet count can lead to an increased risk of bleeding and purpura. TTP, as with other microangiopathic hemolytic anemias , is caused by spontaneous aggregation of platelets and activation of coagulation in the small blood vessels. Platelets are consumed in the coagulation process, and bind fibrin, the end product of the coagulation pathway. These platelet-fibrin complexes form microthrombi which circulate in the vasculature and cause shearing of red blood cells, resulting in hemolysis The symptoms of TTP may at first be subtle starting with malaise, fever, headache and sometimes diarrhea. As the condition progresses clots (thrombi) form within blood vessels and platelets (clotting cells) are consumed. Bruising, and rarely bleeding, results and may be spontaneous. The bruising often takes the form of purpura while the most common site of bleeding, if it occurs, is from the nose or gums. Larger bruises (ecchymoses) may also develop. Clots formed within the circulation can temporarily disrupt local blood supply. TTP preferentially affects the blood vessels of the brain and kidneys. Thus a patient may experience headache, confusion, difficulty speaking, transient paralysis, numbness or even fits whilst high blood pressure (hypertension) may be found on examination Classically, the following five features are indicative of TTP Thrombocytopenia (low platelet count), leading to bruising or purpura Microangiopathic hemolytic anemia (anemia, jaundice and a blood film featuring evidence of mechanical fragmentation of red blood cells) Neurologic symptoms (fluctuating), such as hallucinations, bizarre behavior, altered mental status, stroke or headaches Kidney failure Fever

Erikson's stages of psychosocial development Identity vs. Role Confusion (Adolescence, 12 to 19 years) The adolescent is newly concerned with how they appear to others. Superego identity is the accrued confidence that the outer sameness and continuity prepared in the future are matched by the sameness and continuity of one's meaning for oneself, as evidenced in the promise of a career. The ability to settle on a school or occupational identity is pleasant. In later stages of Adolescence, the child develops a sense of sexual identity. As they make the transition from childhood to adulthood, adolescents ponder the roles they will play in the adult world. Initially, they are apt to experience some role confusion- mixed ideas and feelings about the specific ways in which they will fit into society- and may experiment with a variety of behaviors and activities (e.g. tinkering with cars, baby-sitting for neighbors, affiliating with certain political or religious groups). Eventually, Erikson proposed, most adolescents achieve a sense of identity regarding who they are and where their lives are headed. Robert Havighurst: Developmental Theorist Adolescence (13 to 18 years) 1. Achieving new and more mature relations with age-mates of both sexes 2. Achieving a masculine or feminine social role 3. Accepting one's physique and using the body effectively 4. Achieving emotional independence of parents and other adults 5. Preparing for marriage and family life Preparing for an economiccareer 6. Acquiring a set of values and an ethical system as a guide to behavior;developing an ideology 7. Desiring and achieving socially responsible behavio