ery upset about its recurrence. Although he was aware that after splenectomy there is a small chance of recurrence, he had convinced himself that he was free from the disease. He had been asymptomatic for many years. He is disheartened by the representation of his disease, and knows that there are now few treatment options available to him. He feels that being chronically ill will impair his ability to look after his wife and young child. He is especially worried about the long-term effects of the repeated corticosteroid therapy that he will now require and how this will affect his future health.
             General: On examination the patient looks well. He is comfortable at rest and friendly.
             „asubconjunctival haemorrhage
             „alymph node enlargement in the neck or the axillae
             Skin: Purpura on feet extending up to shins
             Liver edge palpable but not enlarged
             „apalpable masses, „aascites
             Apex beat palpated in left 5th intercostal space in the midline
             „ascars, trachea central, crico-sternal distance 2.5cm
             Good vesicular breath sounds throughout
             Skin: Purpura over feet extending up to the shins, worse over the medial and lateral malleoli.
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