Abstract
Background & Objectives: Immature Platelets or Reticulated Platelets (RP) are newly released platelets which are larger and more reactive than mature platelets and contain RNA. Immature Platelet Fraction (IPF) is the percentage of RPs. It reflects the severity of damage to platelets and the generation of platelets in bone marrow. The objective of the study was to assess whether IPF could potentially be used as a prognostic indicator of platelet recovery in patients with thrombocytopenia.
Methods: This is a prospective observational study in 141 eligible patients who were followed up over a period of 5 days. Serial monitoring of platelet count and IPF were conducted on 1st,3rd and 5thday. An IPF value of >6.1% was considered as high. An increase of platelet count of 20,000cells/μL was considered as significant. The study population was grouped based on clinical diagnosis, aetiology of thrombocytopenia and severity of thrombocytopenia. Descriptive and inference analysis were done. Correlation between change in platelet count with respect to change in IPF was analysed.
Results and Discussion: Of 141 patients 68.1% were males and 31.9 % were females. Majority of the patients belonged to age group 21-40 years (42.6%). Dengue was diagnosed in 68.1% of the total patients. Pearson correlation coefficient between change in IPF and change in platelet counts on day1, day3 and day5 were -0.393, -0.455 and -0.393 respectively. IPF had an inverse correlation with respect to platelet counts. p-value obtained was <0.001 which was statistically significant. Kruskal-Wallis Test was done to find if there is any significant difference in IPF among the aetiologies. The p-value obtained was 0.003 which was statistically significant. Hence pair wise comparison of different aetiologies was done. It was found that peripheral destruction of platelets had a significant association with IPF compared to all other aetiologies.
Conclusion: There was a moderate inverse correlation between IPF and platelet counts. As the IPF levels fell, platelet levels tended to increase. It had some predictive value in anticipating platelet recovery. In thrombocytopenia, due to peripheral destruction IPF can potentially be used as a screening test.
References
- Konkle BA. Disorders of Platelet and Vessel Wall. In Kasper DL, Hauser SL, Jameson JL, Fauci AS, Longo DL, Loscalzo J. Harrison's Principles of Internal Medicine. Newyork: McGraw Hill; 2015; 725.
- Watson HG, Craig JIO, Manson LM. Blood disease. In Walker BR, Colledge NR, Ralston SH, Penman ID. Davidson’s Principles & Practice of Medicine. 22nd ed. Edinburgh: Churchill Livingstone Elselvier; 2014;1007-8.
- Briggs C, Kunka S, Hart D, Oguni S, Machin SJ. Assessment of an immature platelet fraction (IPF) in peripheral thrombocytopenia. British Journal of Haematology. 2004 July; 126(1):93-9.
- Dadu T, Sehgal K, Joshi M, Khodaiji S. Evaluation of the immature platelet fraction as an indicator of platelet recovery in dengue patients. International Journal of Laboratory Hematology. 2014 October; 36(5): 499-504.
- Suman F, D'Cruze L, Rajendran R, Varadarajan S. Dengue:platelet and immature platelet dynamics a study done at a tertiary care centre from South India. International Journal of recent trends in science and technology. 2014; 12(3): 620-3.
- De Blasi R, Cardelli P, Costante A, Sandri M, Mercieri M, Arcioni R. Immature platelet fraction in predicting sepsis in critically ill patients. Intensive Care Medicine. 2013 April; 39(4):636-43.
- Van der LN, Klinkenberg LJ, Meex SJ, Beckers EA, deWit NC, Prinzen L. Immature Platelet fraction measured on sysmex XN hemocytometer predicts thrombopoietic recovery after autologous stem cell transplantation. Eur J Haematol. 2014; 93(2):150-6.
- Hulley SB, Browner WS,Newman TB. Estimating Sample Size and Power: Applications and Examples. In: Hully SB, Cummings SR, Browner WS, Grady DG, Newman TB, editors. Designing Clinical Research. 3rdEdition. Philadelphia: Lippincott Williams &Wilkins;2007;89.
- Abe Y, Wada H, Tomatsu H, Sakaguchi A, Nishioka J, Yabu Y, Onishi K. A simple technique to determine thrombopoiesis level using immature platelet fraction (IPF). Thrombosis research. 2006; 118:463-9.
- Saigo K, Sakota Y, Masuda Y, Matsunaga K, Takenokuchi M, Nishimura K, Sugimoto T, Sakurai K , Hashimotto M, Yanai T, Hayakawa A, Takeshima Y, Nomura T, Kubota Y, Kumagai S. Automatic detection of immature platelets for decision making regarding platelet transfusion indications for pediatric patients. Transfusion and Apheresis Science. 2008; 38:127-32.
- Cremer M, Paetzold J, Schmalisch G, Hammer H, Loui A, Dame C, et al. Immature platelet fraction as novel laboratory parameter predicting the course of neonatal thrombocytopenia. British Journal of Haematology. 2009 February; 144(4):619-21.
- Cybulska A, Meintker L, Ringwald J, Krause SW. Measurements of immature platelets with haematology analysers are of limited value to separate immune thrombocytopenia from bone marrow failure. British Journal of Haematology. 2017 May; 177(4): 612-9.
- Bhalla A, Bagga R, Dhaliwal L, Sharma R, Varma S. Steroid responsive prolonged thrombocytopenia in dengue. Indian Journal of Medical Sciences Mumbai. 2010 February; 64(2):90-3.
- Pons I, Monteagudo M, Lucchetti G, Munoz L, Perea G, Colomina I, et al. Correlation between immature platelet fraction and reticulated platelets. Usefulness in the etiology diagnosis of thrombocytopenia. European Journal of Haematology. 2010 August; 85(2):158-63.
Corresponding Author
Roshan Paul Mampilly
Junior Resident, Department of Medicine, JMMC and RI, Thrissur
DOI: https://dx.doi.org/10.18535/jmscr/v6i8.98
