Role of Immature Platelet Fraction in the Evaluation Of Patients Having Thrombocytopenia

Abstract

INTRODUCTION - Thrombocytopenia is a common clinical problem, which is defined as a platelet count less than 15x109 /L although a cut off value of 10 x 109/L is more appropriate to identify clinically significant thrombocytopenia. Causes of thrombocytopenia can be subdivided into decreased platelet production, increased platelet destruction, increased splenic sequestration, and dilution. Investigation requires consideration of patient age, baseline platelet count, medical and surgical history, including any bleeding or thrombotic manifestations, family history, medication history, and physical examination findings. Immature Platelet fraction (IPF) is a novel parameter that helps in the diagnosis of thrombocytopenia by predicting megakaryopoiesis activity. So, this study is initiated to evaluate whether IPF can differentiate between thrombocytopenia due to decreased platelet production or increased platelet destruction and other causes of thrombocytopenia. OBJECTIVE: To study the utility of platelet parameters like Immature platelet fraction (IPF), Plateletcrit (PCT), Mean platelet volume (MPV), in cases of patients having thrombocytopenia. MATERIALS AND METHODS: A prospective hospital-based study was carried out on all the patients presenting with platelet count <100,000/μL. The patients who had a recent blood transfusion and cases which showed EDTA induced pseudo- thrombocytopenia were excluded from the study. STUDY PERIOD: 1st December 2018 to 30th May 2020. DocuSign Envelope ID: 4B5F006B6D66D329--3B930656-4-495D9AE--A9D4120A--1230F4E4F0412E61681BFEEE xv SAMPLE COLLECTION - Blood samples were collected in EDTA anticoagulated vacutainers and then run on SYSMEX XN 1000 for determination of Platelet count, IPF%, MPV and PCT. CBC parameters like Haemoglobin (Hb), RBC count, Total WBC count, WBC differential count, MCV, MCH, MCHC, Hematocrit (HCT) and Red Cell Distribution width (RDW) were taken as part of routine analysis. A peripheral smear examination was done for all patients. RESULTS: A total of 172 patients were enrolled in the study. IPF% was found to be higher in thrombocytopenia due to increased destruction of platelets thus indicating higher megakaryopoiesis activity in these patients. Therefore, the invasive procedure of bone marrow study can be avoided in patients having responsive marrow. MPV and PCT were also slightly higher in thrombocytopenia due to increased platelet destruction than in patients with thrombocytopenia due to decreased platelet production. IPF% was found to be a better marker than other two parameters and the cut off value of IPF % biomarker to distinguish between thrombocytopenia due to increased platelet destruction and thrombocytopenia due to decreased platelet production was 9.2%. CONCLUSION: The estimation of IPF%, MPV and PCT is simple and rapid method that can be used for the evaluation of thrombocytopenia. IPF% is better marker to differentiate whether thrombocytopenia is due to increased platelet destruction or decreased platelet production. Thus, can be used effectively to determine the underlying etiology and the procedure of bone marrow biopsy can be avoided.