Immature platelet fraction and its role in thrombocytopenia assessment | ||
| Egyptian Journal of Hematology and Bone Marrow Transplantation | ||
| Volume 11, Issue 12, March 2024, Pages 18-20 | ||
| Document Type: Original Article | ||
| DOI: 10.21608/ejhbmt.2024.406906 | ||
| Authors | ||
| Mostafa El-Razzaz1; Emad Abdelmohsen1; Ahmed Raslan* 2; Gehad Fekry1; Fady Hennawy1 | ||
| 1Clinical Hematology and Bone Marrow Transplant Unit, Internal Medicine Department, Faculty of Medicine, Ain Shams University | ||
| 2Clinical Pathology Department, Faculty of Medicine, Al-Azhar University | ||
| Abstract | ||
| Background: Thrombocytopenia is primarily attributed to either excessive destruction or consumption of platelets in the bloodstream, or insufficient production of platelets in the bone marrow. Hyper-destructive forms of thrombocytopenia, such as immune thrombocytopenic purpura (ITP), disseminated intravascular coagulation (DIC), and thrombotic thrombocytopenic purpura (TTP), arise from accelerated platelet breakdown and utilization. In contrast, hypo-productive thrombocytopenia refers to conditions where platelet production is impaired, as seen in disorders like aplastic anemia (AA) and myelodysplastic syndromes. It can also occur when the bone marrow is compromised by infiltration of solid tumors, fibrosis, or leukemia (1). Distinguishing between decreased platelet production and increased destruction is crucial for effective clinical management. Assessing thrombopoietic activity, or the bone marrow's ability to produce platelets, can guide the accurate diagnosis of thrombocytopenia and help avoid inappropriate platelet transfusions. Additionally, evaluating this activity can provide insights into the potential for spontaneous platelet recovery, which is useful in determining the need for prophylactic platelet transfusions (2). The objective of this study is to demonstrate the significance of the Immature Platelet Fraction (IPF) in evaluating thrombocytopenia patients and confirm the clinical efficacy as a diagnostic tool for differentiation between different etiologies of thrombocytopenia. Additionally, the study aims to ascertain the importance of IPF in monitoring of patients with thrombocytopenia and early prediction of platelet recovery. Methods: This was a prospective case control study including 100 participants: 50 adult patients with newly diagnosed thrombocytopenia for different cause (including decreased production or increased destruction of the platelet) and 50 healthy age and sex matched control. The duration of the study was 6 months IPF was measured at first time of diagnosis when platelet count less than 50 x 109/L and followed until platelet count exceed 50 x 109/L or for ten days which is closer. Based on the cause of thrombocytopenia, the cases were divided into two groups and the difference in IPF value was evaluated between the two groups Results: Our study revealed that Immature Platelet Fraction (IPF) could effectively predict the natural recovery of platelet counts several days in advance. Patients were classified based on the etiology of thrombocytopenia, and those with increased peripheral destruction exhibited higher IPF values (12.97%, range 6.57–19.37%) than patients with bone marrow suppression (4.7%, range 1.6–7.8%). The difference was statistically significant (p = 0.001). This early prediction aids in clinical decision-making, allowing healthcare providers to avoid unnecessary platelet transfusions in patients with Immune Thrombocytopenia (ITP) or those undergoing chemotherapy. Additionally, our findings confirmed that the IPF could forecast platelet recovery to specific levels ahead of time in these patient populations. Conclusion: IPF is a robust marker for distinguishing hyper-destructive/consumptive thrombocytopenia from hypo-productive thrombocytopenia. These markers reflect bone marrow thrombopoietic activity and can reliably predict platelet recovery in patients with ITP or those undergoing chemotherapy, thereby guiding therapeutic decisions, and reducing the need for unnecessary platelet transfusions. Keywords: thrombocytopenia, immature platelet fraction (IPF), immature thrombocytopein purpura (ITP), bone marrow. | ||
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