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Immune thrombocytopenia (ITP) is an autoimmune disease characterized by the breakdown of immune tolerance. Impairment of the cellular immunity is primarily evaluated by the levels of the cytokines which can help in predicting the course of ITP. We aimed to assess the levels of IL4 and IL6 in children with ITP and evaluate their role in the pathogenesis and prognosis of this disease. A prospective cohort study was carried on 60 children (15 patients with newly diagnosed ITP, 15 patients with persistent ITP, 15 patients with chronic ITP and 15 healthy children as a control group). Serum IL-4 and serum IL-6 were measured using Human IL-4 and IL-6 ELISA kit in patients and controls. Patients with newly diagnosed and persistent ITP had significantly higher levels of IL4 and IL6 compared to patients with chronic ITP and healthy controls (p Conclusion: Serum IL-4 and IL-6 may have a role in the pathogenesis of primary ITP. IL-4 seems to be a good predictor to treatment response. What Is Known:• There is a delicate balance of specific cytokine levels in immune thrombocytopenia, which has an important role in the immune system and is known to be deregulated in autoimmune diseases. changes in IL-4 and IL-6 might be involved in the pathogenesis of newly diagnosed ITP in both paediatric and adult patients.• We conducted this research study to measure the serum level of IL-4 and IL-6, in newly diagnosed, persistent and chronic ITP patients and study their relation to disease pathogenesis as well as patient’s outcome.What Is New:• We found that IL4 seems to be a good predictor to treatment response and it was a very interesting observation in our study, and to the best of our knowledge, there is no published data about this finding.

This study about Factors that delay return to work of COVID-19 positive health care workers at King Saud medical city Riyadh Saudi Arabia.2020 Coronaviruses (CoV) are a large family of RNA viruses that cause illnesses ranging from the common cold to more severe diseases such as Middle East respiratory syndrome (MERS-CoV) and severe acute respiratory syndrome (SARS-CoV). The aim of this study is to determine the factors that delay return to return to work among COVID-19 positive HCPs also to study the relationship of the associated risk factors and the delay in return to work among positive COVID-19 HCPs and to minimize the delay in return to work among COVID-19 positive HCPs which will maintain staffing levels to provide adequate care to all patients. Health care professional is defined as all staff in the health care facility involved in the provision of care for a COVID-19 infected patient, including those who have been present in the same area as the patient, as well as those who may not have provided direct care to the patient, but who have had contact with the patient’s body fluids, potentially contaminated items or environmental surfaces. Sampling method: The design of the sampling for this study will be Stratified Random Sampling (StRS) cross section study. This study about Factors that delay return to work of COVID-19 positive health care workers at King Saud medical city Riyadh Saudi Arabia mc.2020 Coronaviruses (CoV) are a large family of RNA viruses that cause illnesses ranging from the common cold to more severe diseases such as Middle East respiratory syndrome (MERS-CoV) and severe acute respiratory syndrome (SARS-CoV). The aim of this study is to determine the factors that delay return to return to work among COVID-19 positive HCPs also to study the relationship of the associated risk factors and the delay in return to work among positive COVID-19 HCPs and to minimize the delay in return to work among COVID-19 positive HCPs which will maintain staffing levels to provide adequate care to all patients. Health care professional is defined as all staff in the health care facility involved in the provision of care for a COVID-19 infected patient, including those who have been present in the same area as the patient, as well as those who may not have provided direct care to the patient, but who have had contact with the patient’s body fluids, potentially contaminated items or environmental surfaces. Sampling method: The design of the sampling for this study will be Stratified Random Sampling (STRS) cross section study will use SPSS to analysis.

Aflatoxin (AF) contamination of food products is still a major health issue globally. Prior studies suggest that exposure to AFs during pregnancy has harmful fetal outcomes. This preliminary study was designed to assess serum AFB1 levels in neonatal jaundice (NNJ) secondary to glucose-6-phosphate dehydrogenase (G6PD) deficiency. Twenty-four full-term neonates with hemolytic jaundice secondary to G6PD deficiency were enrolled in the study. Erythrocyte G6PD status was assessed colorimetrically, and serum aflatoxin B1 (AFB1) concentrations were measured by high-performance liquid chromatography. The results revealed that AFB1 was detected in 58% (14/24) of the studied newborns while detected in 75% (18/24) of their mothers. AFB1 positive cases had a highly significantly lower birthweight and G6PD activity (P = 0.001, each). Birthweight (r = − 0.574, P = 0.032) and G6PD activity (r = − 0.585, P = 0.028) negatively correlated with serum AFB1 levels while serum alanine aminotransferase activity positively correlated with serum AFB1 levels (r = 0.536, P = 0.048). Maternal AFB1 exposure is associated with adverse birth outcomes as verified by the low birthweight and the evident decline in the activity of G6PD enzyme with the resultant hemolytic NNJ.

Background: Acute kidney injury (AKI) occurs in approximately 40% of children undergoing cardiac surgery and is a risk factor for morbidity and mortality. Such injury leads to several complications, including fluid and electrolyte disturbances. Objective: To determine prevalence of acute kidney injury in pediatric patients with congenital heart disease following open heart surgery. Patients and Methods: We conducted a case control study on 20 patients with congenital heart disease (10 males and 10 females) with mean age of 3.39 ± 1.17 years old, and a range from 1 to 5 years old. They were recruited from Pediatric Cardiothoracic Unit, Zagazig University Hospital and 20 sex and age matched healthy children worked as control group. Results: The mean age of our patients was 3.39 ± 1.17 years old with a range from 1 to 5 years. 50% were males and 50 % were females with no statistically significant difference between both groups regarding age and sex. about 1/3 of the studied group had ASD (30 %), while 1/4 of them had Fallot tetralogy (25 %), and only 15% of them had VSD, subaortic membrane and PM + VSD. The mean serum creatinine level was 0.8 ± 0.15mg/dl, with a range from 0.22 - 0.9 mg/dl. 70% of the patients had no acute kidney injury, 15% developed AKI stage 1 and 15% developed stage 2 AKI. In addition, all patients with AKI needed dialysis. Conclusion: Present study identified that high percentage of pediatric patients with congenital heart disease following open-heart surgery developed acute kidney injury.

Several genetic and non-genetic risk factors are implicated in the etiology and pathogenesis of primary immune thrombocytopenia (ITP). Protein tyrosine phosphatase non-receptor 22 gene (This case-control study was designed for assessing the contribution ofFrequency of

Acute Lymphoblastic Leukemia (ALL) is the most common malignancy in children. Venous thromboembolism (VTE) is relatively common in children with acute ALL that usually appears after the diagnosis or during therapy secondary to many associated risk factors. Here in we report for the first time a child who developed cerebral venous sinus thrombosis (CVST) prior to the diagnosis of ALL.

Background: Idiopathic (immune) thrombocytopenic purpura (ITP) is a heterogeneous clinical disorder characterized by immune-mediated platelet destruction. ITP is usually a benign, self-limiting disease in children. Objective: To assess prevalence, prognosis, and outcome of Egyptian children with primary immune thrombocytopenia. Patients and Methods: This cross-sectional study was carried on 80 children (1-13 years) with primary ITP who presented to the Pediatric Hematology Unit and outpatient clinic of Zagazig University Hospitals, during the period from April 2020 to June 2021. Patients were divided into two groups; Group (1): included 20 healthy matched subjects (control), Group (2): included 60 patients with primary ITP. The group was subdivided into 3 subgroups, Subgroup (2A) included 20 patients with newly diagnosed ITP, Subgroup (2B) included 20 patients with persistent ITP, and Subgroup (2C) included 20 patients with chronic ITP. Results: There were significant differences between the studied groups in age, sex, and weight. There was a statistically significant association between prognosis and general characteristics of the studied ITP patients. Conclusion: primary ITP in children is a nonthreatening and self-limited disease, usually lasting less than one year, and chronic form has different prognostic parameters. The use of these parameters can early distinguish children who are expected to have short and uneventful disease duration, to minimize their exposure to pharmaceutical intervention.

Background: Accurate estimation of gestational (GA) is the basis of vital decisions in pregnancy and hence its importance in obstetric management. Crown rump length (CRL) has been proved to be a reliable parameter for the estimation of pregnancy age especially from 7 to 10 weeks. Additionally, it was demonstrated that, the gestational sac volume (GSV), embryonic volume (EV), CRL are important parameters for the early diagnosis of growth disorders.Objective: The aim of the current work was to assess the correlation of pregnancy outcome with gestational sac volume in relation to embryonic volume at )7‐10) weeks of gestation.Patients and methods: This was a prospective observational cross-sectional study carried out on 100 pregnant women with singleton pregnancy that belonging to7-10 week of pregnancy attending a routine antenatal checkup at Outpatient Clinic Of Obstetrics and Gynecology Department, Mansoura University Hospital.Results: Caesarean section (CS) was the most frequent mode of delivery among the studied cases. The average GSV, EV and CRL were higher among females with higher gestational age. EV and GSV were demonstrated to be significant predictors of CRL. CRL=1.55+0.02*GSV+0.08*EV. GSV was displayed to be a significant predictor of fetal birth weight. Fetal birth weight=2.94+0.008*GSV.Conclusion: It could be concluded that the GSV and EV reference intervals established in the present study can be used as normal parameters in future studies assessing cases at risk for adverse pregnancy outcomes.

Previous studies have revealed that the processes of tumor angiogenesis, metastasis and invasiveness are highly dependent on components of the blood coagulation cascade. Tissue factor (TF) is one of the key proteins in coagulation. Cumulative evidence suggested that in addition to its role in coagulation, TF regulates intracellular signaling pathways that serve an important role in angiogenesis, tumor development and metastasis. In the present study, TF expression in neuroblastoma as well as its association with tumor stage, pathology and outcome were assessed. A total of 40 formalin-fixed paraffin-embedded tissues were evaluated for TF expression by immunohistochemical analysis. Results revealed that TF expression was positive in 75% of the analyzed tumor tissues. No significant association between TF expression and sex, age, tumor stage or disease pathology was observed. MYCN proto-oncogene bHLH transcription factor (MYCN) was upregulated in 45% (n=18) of the study cases. Positive TF expression was observed in 94.4% of patients (n=17) with upregulated MYCN, while 59% of patients (n=13) with normal MYCN showed positive TF expression (P

Background: Chronic ITP is a very common disease in children. Most treatment options have focused on slowing platelet destruction like corticosteroids and IVIG. These treatments are not always effective, or have only a transient effect, and treatment related adverse events often restrict further use. Impaired platelet production has been evolved as a potential disease mechanism for ITP. As a result, growth factor and growth factor analogue stimulation of megakaryopoiesis has also been investigated. Objective: is to evaluate the efficacy and safety of eltrombopag for the treatment of children and adolescents with chronic ITP. Subjects and methods: It was a prospective cohort study which was conducted on forty patients (22 males and 18 females) with chronic ITP. They were treated with eltrombopag for a period ranged from 6 months to 2 years after failure of first line of treatment (steroids, IVIG or both). Patients started eltrombopag with mean initial platelet count 14.4 X 103 / uL and were evaluated after at least 6 months of therapy. The study was approved by the academic and medical ethics committee of Zagazig University and a written informed consent was obtained from all patients. Results: Thirty patients (75%) responded to eltrombopag with a mean platelet count of 100.9 X103/ uL while 10 patients (25%) did not respond to the drug. Mean platelet count was significantly higher after eltrombopag therapy (100.9 ± 65.97 versus 14.4 ± 8.87, P < 0.001). The longer the duration of treatment, the higher the mean platelet count after treatment (r = 0.4, P < 0.001). Only 43.3% of responders received combined treatment with IVIG and steroids versus 20% of non-responders (p = 0.006). Conclusion: Eltrombopag is an effective, well tolerated and safe drug to restore platelet counts at levels high enough to prevent bleeding events in children with chronic ITP.

ATP binding Cassette gene member 1 (ABCB1) polymorphism has been incriminated in susceptibility to many malignant, infectious and autoimmune diseases. Recently, it was reported that ABCB1 polymorphisms might have a link to disease progression as well as response to therapy. We aimed to study the association between ABCB1 gene polymorphism and glucocorticoid response in children with newly diagnosed immune thrombocytopenia (ITP). A case control study was conducted on 90 newly diagnosed children with ITP and 90 healthy controls over a period of 1 year. ABCB1 (C3435T) polymorphism was determined by restriction fragment length polymorphism-polymerase chain reaction (RFLP-PCR) in patients and controls. There was no significant difference between patients and controls as regards to frequency of different ABCB1 genotypes (CC, CT, and TT genotypes were 44.4%, 36.7%, and 18.9% respectively in patients and 48.9%, 38.9%, and 12.2% respectively in controls, P value = 0.18). 80% of patients who received steroids alone or steroids in combination with intravenous immunoglobulin showed complete recovery. There was highly significant relationship between ABCB1 genotypes and response to steroids where 55 % of responders had CC (wild) genotype while 40 % of nonresponders had TT (mutant) genotype. We concluded that ABCB1 gene polymorphism may contribute to the response to steroids in Egyptian children with ITP where patients with homozygous CC genotype responded better to steroids than patients with homozygous TT genotype. These results may help us choose the appropriate initial treatment in these children.

Background: The aim of this study was to reveal the frequency of Necrosis Factor _Alpha Gene Polymorphism in evaluation of severity and outcome of chronic immune thrombocytopenia in pediatric department of Zagazig University hospitals. Methods: We conduct a retrospective case control on 40 children diagnosed with chronic ITP and 40 age and sex healthy matched subjects as a control recruited from outpatient hematology clinic Faculty of Medicine, Zagazig University. Results: We found a highly significant difference between ITP group and control group as regarding TNF-α alleles where A allele was expressed in 43.7% of cases versus 17.5% 0f control, P value

Background Osteonecrosis (ON) is one of the major therapy‐related complications in childhood acute lymphoblastic leukemia (ALL). The purpose of the current study is to assess the frequency of ON in children with ALL and to detect whether polymorphisms in vitamin D receptor gene (VDR) and plasminogen activator inhibitor‐1 (PAI‐1) gene can affect the risk of ON. Patients and Methods Nighty‐six ALL children were enrolled. Serum 25‐hydroxyvitamin D 25(OH)D levels were performed in addition to the detection of polymorphisms in PAI‐1and VDR genes by polymerase chain reaction. Results Ten out of 96 patients had ON (four males and six females aged above 10 years) and had an insufficient level of 25(OH)D. Fifty‐two percent of patients had PAI‐1 GG genotype while 48% had PAI‐1 GA genotype. PAI‐1 polymorphism was detected in 60% of all ON cases. The frequencies of VDR genotypes were CT (56.3%), CC (39.6%), and TT (4.2%). Osteonecrosis was found in eight patients with CC genotype and in two patients with CT genotype. Conclusion Osteonecrosis can develop early during the therapy of ALL. Older age and insufficient level of 25(OH)D were considered important risk factor for the development of osteonecrosis. PAT‐1 and VDR gene polymorphism may be a genetic risk factor in its pathogenesis., Osteonecrosis can develop early during the therapy of ALL. Older age and insufficient level of 25(OH)D were considered an important risk factor for the development of osteonecrosis. PAT‐1 and VDR gene polymorphism may be a genetic risk factor in its pathogenesis.

Background:Ophthalmic complications in pediatric acute lymphoblastic leukemia (ALL) have become serious and recognition of ocular manifestations of leukemia is fundamental. In this study, we aimed to detect radiological findings among ALL patients.Patients and methods:This cross sectional study was conducted in Pediatric Oncology Unit and Ophthalmology Department; Faculty of Medicine; Zagazig University with a total of 45 patients diagnosed with ALL (18 patients were denovo ALL, 14 patients were receiving treatment of leukemia and 13 patients finished their treatment protocol and were on follow up schedule). Detailed radiological work up was done including MRI of brain and both orbits, fundus photography, fluorescein angiography (FA), optical coherence tomography (OCT) and orbital CT.Results:Ocular manifestations were detected in 35.6% of ALL patients by ophthalmic examinations. 44.4% of ALL patients had abnormal brain MRI and most commonly, ischemic changes, post-radiation leukomalacia and CNS infiltration were detected. Twenty-two percent of the studied cases reported abnormal orbital MRI and most common abnormalities were sutural metastasis and optic nerve affection. Fundus photographs were done for selected patients. Optic nerve head leukemic infiltration, choroidal, retinal and vitreal infiltration were detected (4.44%). Moreover, CMV retinitis was detected in one patient.Conclusions:Several ocular abnormalities are present in pediatric ALL and the most common are retinal lesions. Knowledge about ocular problems in children with ALL could be beneficial to reduce morbidity and mortality.

Phagocytosis of autoantibody-sensitized coated platelets through Fc gamma receptors on phagocytic cells is an important mechanism of thrombocytopenia in primary immune thrombocytopenia (ITP).We aimed to investigate the contribution of the FcγRIIa and FcγRIIIa genes polymorphism to the risk of ITP and their association with disease characteristics in Egyptian children.A case control study was conducted on eighty children with primary ITP and eighty age and sex healthy matched subjects as a control group. The FcγRIIa and FcγRIIIa genes polymorphism was detected using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP).We found that the FcγRIIa-131H and -131R allele frequencies were 51.3 % and 48.7%, respectively, in children with ITP, versus 75% and 25%, respectively, in controls (p = 0.002). The compound heterozygous HR genotype was significantly higher in ITP patients (p0.05). The FcγRIIIa-158F and -158V allele frequencies were 46.3% and 53.7%, respectively, in children with ITP, versus 70% and 30%, respectively, in controls (p = 0.002). The compound heterozygous VF genotype was significantly higher in ITP patients (p0.05). The combined HR/FV genotype was 47.5% in ITP patients, versus 10% in controls (p0.001). No significant difference was found between children with newly diagnosed ITP and those who developed chronic ITP, regarding the frequency distribution of the FcγRIIa and FcγRIIIa alleles and genotypes (p0.05).There is a possible association of the FcγRIIa and FcγRIIIa genes polymorphism with the risk for, and genetic susceptibility to ITP in Egyptian children, but large-scale studies are still needed to support our findings.

Concepts surrounding the mechanisms of thrombocytopenia in ITP have shifted from the traditional view of autoantibody mediated platelet destruction to more complex mechanisms in which impaired platelet production, T-cell-mediated effects, and disturbed cytokine profiles play a role. Interleukin 27 (IL-27) plays pleiotropic roles in immunomodulation and autoimmune diseases.We aimed to determine the level of IL-27 in patients with ITP and its relationship to patient and disease characteristics as well as disease chronicity and response to treatment.Sixty childrens with primary immune thrombocytopenia were consequetively enrolled in this study as well as 20 age and sex matched healthy controls.ITP patients had significantly higher levels of IL-27 than controls (770.6 and 373.8 pg/ml, respectively). Patients with acute ITP had the highest levels of IL-27 among patient groups, while patients in remission had the lowest IL-27 levels (860.1and 622.9 pg/ml, respectively). Patients who received IVIG and combined steroids plus IVIG had significantly higher IL-27 levels than others. Patients who received Eltrombopag had significantly lower IL-27 levels than others.IL-27 seems to play a role in pathogenesis of childhood ITP. IL-27 can be used as a predictor for disease occurrence as well as responsiveness to treatment.

Aflatoxin (AF) contamination of food products is still a major health issue globally. Prior studies suggest that exposure to AFs during pregnancy has harmful fetal outcomes. This preliminary study was designed to assess serum AFB

We aimed to investigate the role of urinary kidney injury molecule-1 (KIM-1) in detection of subclinical nephrotoxicity in patients with Beta-thalassemia (β-TM) in relation to chelation therapy and to correlate the urinary KIM-1 level with other clinical and laboratory findings. We conducted a cross-sectional study on 66 thalassemic patients. Their ages range from 7 to 22 years. Routine kidney indices and novel urinary KIM/creatinine ratio (U

In beta thalassemia, the degree of globin chain imbalance is determined by the nature of the mutation of the β-gene. β° refers to the complete absence of production of β-globin on the affected allele. β+ refers to alleles with some residual production of β-globin. The homozygous state results in severe anemia that necessitates regular blood transfusion. On the other hand, frequent blood transfusion can lead to iron overload resulting in progressive dysfunction of the heart, Liver as well as multiple endocrinopathies. We studied the impact of genotype on the development of disease complications in patients with β thalassemia. A Cross sectional study was carried on 73 patients with beta thalassemia. Genotyping was determined by DNA sequencing technique. Routine investigations as well as MRI liver and heart were performed to assess iron overload. We found that β+β+ was the most common genotype in our patients followed by β°β° and β°β+. Mean Liver iron content (LIC) was significantly higher in β°β° compared to β°β+ and β+β+ genotypes and mean cardiac T2* was significantly lower in β°β° compared to β°β+ and β+β+ genotypes. Hepatic complications, hepatitis C, cardiac complications and some endocrinopathies were significantly higher in patients with β°β° genotype compared to other genotypes which explain the role of the underlying genetic defect in thalassemia patients in development of disease complications.

Iron overload causes most of the mortality and morbidity associated with thalassemia. Excess iron deposits primarily in the liver, but once a threshold level is reached, iron loading may occur in other tissues such as the heart. Magnetic resonance imaging is a well established technique to noninvasively quantify myocardial and liver iron content. More than 300 disease-causing mutations have been identified. We aimed to determine the impact of genotype on liver iron content in patients with beta thalassemia. Cross sectional study was carried on 73 patients with beta thalassemia. MRI liver and heart was performed to determine hepatic and myocardial iron overload. Genotyping was determined by DNA sequencing technique. The mean liver iron content was 17.4 mg/g dw and mean cardiac T2* was 25.5 ms in our patients. Patients with β(0)β(0) were associated with significantly higher liver and myocardial iron content compared to those with β(0)β(+) and β(+)β(+) genotypes. There was a clear association between genotype and both hepatic and myocardial iron overload. Patients with β(0)β(0) had significantly higher liver and heart iron content compared to those with β(0)β(+) and β(+)β(+) genotypes. Liver iron content was strongly correlated to serum ferritin levels and myocardial iron overload.

Background: An increased risk of cardiovascular complications is reported in survivors of childhood acute lymphoblastic leukemia (ALL). Early identification of impaired vascular health may allow for early interventions to improve outcomes. Aim: The study was conducted to assess the endothelial dysfunction in ALL survivors using a new marker, serum endocan, and measurement of the mean common carotid arteries intima media thickness (cIMT). Methods: A case-control study was conducted on 100 childhood ALL survivors (aged 6–18 years), with 80 healthy age and sex-matched children as a control group. Lipid profile, hepatitis markers, and serum ferritin where measured, in addition to the measurement of serum endocan. and cIMT by B-mode high-resolution ultrasonography for all study participants. Results: Triglycerides, total cholesterol, post prandial glucose, and serum ferritin were significantly higher in ALL survivors than controls ( p Conclusions: The survivors of childhood ALL demonstrated an elevated level of serum endocan and increased cIMT. These can be used as predictors of endothelial dysfunction, and, as a consequence, the risk of developing premature atherosclerosis.

Background: Primary immune thrombocytopenia (ITP) has been treated with steroids or immune-suppressive. Thrombopoietin receptor agonists (TPO-RAs), changed the treatment landscape for ITP. Romiplostim and Eltrombopag were FDA approved for use in pediatric patients ≥1 year with ITP of >6 months' duration and insufficient response to previous therapy. Following the guidelines is not always feasible in practice. Aim and Methodology Centers treating more than 25 new cases/year with good recording system were included; aiming to report outcome, adverse events (AEs) and deviation from guidelines. Newly diagnosed ITP children were excluded. Data was collected from January 2017- June 2019; children age >1 to 18 years with persistent ITP (3- 1 to 12 years; or in 50 mg/day for those >12-18 years; dose was escalated to 50 or 75mg/day for those 6-12 and >12 years respectively on failure to have PC > 50 x 109/L. Weekly CBC and self-record of bleeding for 1st 24 week then bi-weekly. Failure to show a good response; Eltrombopag dosing should be adjusted to achieve that goal and not to exceed 200 × 109/L. Romiplostim was used in 1 ug/kg and escalated up to 10 ug/kg according to response. Serious AEs were reported to ethical committee within 24 hours. Results Two years Observational study of 204 out of 1080 primary ITP (268 persistent and 812 chronic); 55% females median age 8 years, received Eltrombopag (n=186), Romiplostim (n= 18) from 3-30 months was prescribed after failure of 1-5 lines of therapy in 15% of Persistent ITP and 20% of chronic ITP. Adequate response at 24 weeks in 60% on Eltrombopag or Romiplostim had a significant reduction in both skin-related and non-skin-related bleeding symptoms). However 50% discontinued treatment; (40% due to inadequate response, 8% irregular availability and 2% due to SAEs). Deviation from guidelines in 40%; (15% started Eltrombopag early between 3-6 months who showed a higher response rate; half of them could stop it without drop of PC); while 20% continued Eltrombopag for >12 month with lack of response after dose escalation at 24th week and 5% were not following the described dose or the regular monitoring. 40% of chronic ITP patients achieved platelet counts of >50 x 109/L or more at least twice. Common adverse events included; headache (10%). myalgia (10%), rhinitis (8%), diarrhea 8% Serious adverse events occurred in 4 (1 elevated transaminases, one unrelated life-threatening bleeding and two high PC; >1000 x109/L). Conclusion: TPO-RAs were used in almost 15% of persistent and 20% of chronic ITP as 2nd line or more therapy and in 90% was Eltrombopag; which produced an excellent response for those 3-6 months; deviating from guidelines. It showed a sustained platelet response in 40% of patients with chronic ITP, however it should be stopped if showing poor response after dose escalation. Disclosures No relevant conflicts of interest to declare.