Characterization Of The Immature Platelet Fraction (IPF) Parameters In Children With Immune Thrombocytopenia

Abstract Background Immune thrombocytopenia (ITP) is characterized by impaired megakaryocte production and maturation, as well as premature platelet destruction. The effect of this disease on platelet production is not clear. The Immature Platelet Fraction (IPF) is a novel parameter available on the Sysmex XE-Series Hematology analyzers. It can be expressed as both IPF percent (IPF %) and absolute IPF count (AIPF#). It has been shown that IPF% is higher in Immune Thrombocytopenia (ITP) than in the normal population, and is an indicator of bone marrow platelet production or thrombopoiesis. Objectives To characterizes the IPF parameters in pediatric patients with ITP at diagnosis and during different phases of the disease (newly diagnosed, persistent, and chronic). Method This is a retrospective, single institution study performed at a tertiary care pediatric hospital. We reviewed the medical charts and electronic databases of all patients with ITP who had measured IPF parameters between June 2011 and June 2013. The standard definitions and terminology of the International Working Group were used. Patient age, phase of ITP at the time of the blood test (newly diagnosed, persistent, and chronic), initial platelet count, IPF%, AIPF#, and type of therapy given (including observation alone) were recorded. We then compared the platelet count, IPF%, and AIPF# between the ITP phases at the time of initial CBC and looked at the relationship between the platelet count and IPF%. Comparisons between groups were performed using Kruskal-Wallis tests or Mann-Whitney tests, as appropriate. Association between measured blood parameters was measured using the Spearman correlation coefficient. Results Conclusion IPF parameters may be useful in understanding the mechanism of ITP through the evolution of the disease. From the time of diagnosis of ITP through progression to chronic ITP, there is a steady decrease in IPF% and increase in AIPF# .The high IPF% in the newly diagnosed setting suggests that megakaryocytes are still active, whereas the lower IPF% in chronic ITP indicates inhibition of megakaryopoiesis or a different underlying pathophysiology. This may have important clinical implications when considering TPO receptor agonist therapy. Disclosures: No relevant conflicts of interest to declare.

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