Ali, Sidra Asad

Shaikh, Muhammad Shariq

English

eCommons@AKU

eCommons@AKUDepartment of Pathology and Laboratory Medicine Medical College, PakistanSeptember 2016Clinical utility of immature platelet fraction - anadvanced parameter in laboratory hematologyMuhammad Shariq ShaikhAga Khan University, muhammad.shariq@aku.eduSidra Asad AliFollow this and additional works at: http://ecommons.aku.edu/pakistan_fhs_mc_pathol_microbiolPart of the Medical Microbiology Commons, and the Medical Pathology CommonsRecommended CitationShaikh, M. S., Ali, S. A. (2016). Clinical utility of immature platelet fraction - an advanced parameter in laboratory hematology. JCPSP:Journal of the College of Physicians and Surgeons--Pakistan, 26(9), 798-799.Available at: http://ecommons.aku.edu/pakistan_fhs_mc_pathol_microbiol/457798 Journal of the College of Physicians and Surgeons Pakistan 2016, Vol. 26 (9): 798-799Sir,Platelets, first described by a German anatomist as'spherules', nearly a century ago, are multifunctionalanucleated cells that play a vital role in hemostasis.They are cytoplasmic fragments of megakaryocytes withaverage platelet count ranging between 150 and 410 x109/L. Platelets act as an initial hemostatic agentthrough their adhesive and cohesive properties leadingto the formation of platelet plug with subsequentactivation of coagulation pathways in order toconsolidate the primary hemostatic plug. However, inpatients with thrombocytopenia, count alone does notprovide precise assessment of bleeding risk and plateletproduction from bone marrow. Analogous to red cellreticulocytes, immature platelets or reticulated plateletsare young platelets that circulate in the peripheral bloodand provide functional status of platelet production bybone marrow.Owing to their high ribonucleic acid (RNA) content,immature platelets can be differentiated from theirmature counterparts. This was first demonstrated byKienast and Schmitz in 1990 utilizing flow cytometry.Since then, several modifications have been developedutilizing multi-color flow cytometric analysis and differentflouro-chromes providing simple, rapid and preciseassessment of reticulated platelets. In modernautomated hematology analysers equipped with thissophisticated method, fluorescent dyes penetrate thecell membrane through a breach created by surfactantand label the RNA. It is reported as percentage of thetotal platelet count (%-IPF). The normal reference rangefor IPF ranges from 1.6 - 7.1% in adults, and 1.0 - 6.8%in children.1Since IPF provides status of bone marrow thrombo-poiesis, it can be utilized for diagnosis and managementof various disorders. Raised IPF levels are seen inconditions with high platelet turnover like disseminatedintravascular coagulation (DIC), thrombotic thrombo-cytopenic purpura (TTP) / hemolytic uremic syndrome(HUS), immune thrombocytopenic purpura (ITP), andblood loss. Whereas, low levels are observed inindividuals with bone marrow suppression such asaplastic anemia and other bone marrow failuresyndromes, nutritional deficiencies and drug inducedmyelosuppression.Besides its role in aiding the diagnosis of abovedisorders, IPF can be utilized to monitor the diseasesprocess and to assess need of platelet transfusion. Indisorders with high platelet turnover like ITP, initially highIPF values tend to decline as the disease responds totreatment. Similarly, low IPF values in drug inducedmyelosuppression and viral hemorrhagic fevers willreturn to normal range with improvement in diseaseprocess. Since IPF levels decline around 24 - 48 hoursbefore improvement in platelet counts, unnecessaryplatelet transfusion can be prevented in suchconditions.2Several other potential uses of IPF have beendocumented in literature. In acute coronary syndromes,it can be used for risk stratification and for monitoring theeffect of anti-platelet treatment; high IPF levels beingassociated with poorer prognosis.3 Recently, a studyperformed in critically-ill patients suggested that IPFcould be a more accurate and sensitive bio-marker ofsepsis than c-reactive protein and procalcitonin.4 A studycomprising 51 patients with myelodysplastic syndrome(MDS) revealed that approximately one-fourth had IPFof more than 10%. Interestingly, this subset of patientswas found to have a karyotype that predicts a poorprognosis in MDS.5The sensitivity of IPF in major clinical conditions (suchas ITP, TTP, DIC, dengue fever, aplastic anemia, MDS,recovery from transplant and chemotherapy) varies from47% to 93%; whereas, specificity of 85% to 98% andpositive predictive values ranging from 83% to 93% havebeen quoted in the literature.IPF values tend to increase in a time-dependent fashionwith formation of platelet clumps or aggregates.Additionally, presence of white cell fragments can alsofalsely increase the values. However, most automatedanalysers in use generate an abnormal platelet scattergram flag when such abnormalities are present. In suchsituations, careful examination of peripheral blood filmalong with vigilant monitoring of these flags are requiredwhile reporting patient results.This technique is now a part of many upcoming modelsof automated analysers providing accurate and valuableinformation of megakaryocytic activity within minutes.This simple, non-invasive and in-expensive toolassesses bone marrow thrombopoietic activity on asingle blood specimen. All these properties are highlydesirable specifically in pediatric settings where bonemarrow examination may not always be practical.REFERENCES1. Seo A, Yuan D, Daniels S, Yuan S, Gallagher M, Wong EC.Reference intervals for immature platelet fraction andimmature platelet count. Int J Lab Hematol 2014; 37:e1-2.LETTER TO THE EDITORClinical Utility of ImmaturePlatelet Fraction - An AdvancedParameter in LaboratoryHematologyLetter to the editor2. Dadu T, Sehgal K, Joshi M, Khodaiji S. Evaluation of theimmature platelet fraction as an indicator of platelet recovery indengue patients. Int J Lab Hematol 2014; 36:499-504.3. Cesari F, Marcucci R, Gori AM, Caporale R, Fanelli A,Casola G, et al. Reticulated platelets predict cardiovasculardeath in acute coronary syndrome patients. Insight from theAMI-Florence 2 study. Thromb Haemost 2013; 109:846-53.4. Park SH, Ha SO, Cho YU, Park CJ, Jang S, Hong SB.Immature platelet fraction in septic patients: Clinical relevanceof immature platelet fraction is limited to sensitive and accuratediscrimination of septic patients from non-septic patients,not to the discrimination of sepsis severity. Ann Lab Med 2016;36:1-8. 5. Sugimori N, Kondo Y, Shibayama M, Omote M, Takami A,Sugimori C, et al. Aberrant increase in the immature plateletfraction in patients with myelodysplastic syndrome: a markerof karyotypic abnormalities associated with poor prognosis.Eur J Haematol 2009; 82:54-60.Sidra Asad Ali and Muhammad Shariq ShaikhSection of Hematology, Department of Pathology andLaboratory Medicine, Aga Khan University Hospital,Karachi.Correspondence: Dr. Muhammad Shariq Shaikh, Section ofHematology, Department of Pathology and LaboratoryMedicine, The Aga Khan University, Stadium Road,Karachi-74800.E-mail: muhammad.shariq@aku.eduReceived: January 14, 2016;   Accepted: June 08, 2016.Journal of the College of Physicians and Surgeons Pakistan 2016, Vol. 26 (9): 798-799 799

Clinical utility of immature platelet fraction - an advanced parameter in laboratory hematology

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Clinical utility of immature platelet fraction - an advanced parameter in laboratory hematology

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