Evaluation of Immature Platelet Fraction in Patients with Fever and Thrombocytopenia and its Clinical Utility

Abstract

Introduction: Thrombocytopenia is very common in dengue and other haematological disorders and the aetiology is multifactorial. Immature Platelet Fraction (IPF) is a novel parameter which is a measure of reticulated platelets and it reflects the rate of regeneration of platelets. Aim: To evaluate the relationship between the IPF and platelet recovery and the consistency of its expression. Materials and Methods: The present study was a retrospective observational study done at Institute of Pathology, Madras Medical College between November 2018 to December 2018. Total 37 patients having fever with thrombocytopenia in dengue and other haematological causes were included for analysis. The platelet count, IPF, Mean Platelet Volume (MPV), Platelet Distribution Width (PDW) and Plateletcrit (PCT) was evaluated at the time of admission and once in every 24 hours and plotted in excel spread sheet. Results: About 86.4% were recovered in 24 hours after attaining the peak, 89.1% showed recovery in 24-48 hours of the rise of the IPF compared to the previous value and 94.5% recovered within 24 hours after the fall in the IPF value. It was observed that 81.8% were recovered when the IPF value ≥10% within 24- 48 hours. IPF readings are able to appreciate even in low platelet count levels but the other platelet recovery parameters did not. Conclusion: IPF is a consistent and reliable marker which can be measured even when the platelet count is low and it also predicts the platelets recovery. It is a promising marker that helps in guiding the decision towards platelet transfusion.

Immature platelet fraction as predictor of platelet recovery in dengue fever

“…Other studies show that the usual reference range for IPF is between 1.6 and 7.1% in adults, while in children, it is between 1.0 and 6.8% [11]. Several studies reported that IPF >10% predicted platelet recovery within 48-72 hours [2,7]. The IPF will start to decrease the following day after reaching its peak value.…”

“…However, prophylactic platelet transfusion for severe thrombocytopenia in hemodynamically stable patients has been demonstrated to be ineffective and unnecessary, according to WHO. To prevent unnecessary platelet transfusions, doctors can use IPF to predict platelet recovery in dengue fever patients [7].…”

“…In cases of bone marrow failure, IPF will decrease. The normal range for IPF is between 1.1 and 6.1 [3,4,7]. Other studies show that the usual reference range for IPF is between 1.6 and 7.1% in adults, while in children, it is between 1.0 and 6.8% [11].…”