Utility of the immature platelet fraction in pediatric immune thrombocytopenia: Differentiating from bone marrow failure and predicting bleeding risk

Utility of the immature platelet fraction in pediatric immune thrombocytopenia: Differentiating from bone marrow failure and predicting bleeding risk
The immature platelet fraction (IPF) is an emerging laboratory test for measuring platelet production/turnover. It has been proposed that these immature platelets are more hemostatic and an increase in IPF more consistent with ITP, compared to BMF.
The two objectives were to examine the ability of IPF to help distinguish patients with BMF from ITP in their initial presentation of thrombocytopenia and to determine whether the IPF or AIPN could identify a subset of patients with ITP who were at increased risk of significant bleeding.
Retrospective chart review of thrombocytopenic patients, 2 months – 21 years old, with platelet counts 50 × 10e9/L at Children's Hospital of Philadelphia (CHOP) from November 1, 2013 to July 1, 2015. Charts reviewed for final diagnosis and bleeding symptoms. A bleeding severity score was retrospectively assigned.
272 patients were reviewed: 97 ITP, 11 BMF, 126 malignancy, 38 other. Cut-off IPF > 5.2% differentiated ITP from BMF with 93% sensitivity and 91% specificity. Absolute immature platelet number differed in all three bleeding severity groups (mild, moderate, severe). On multivariate analysis, an IPF 10.4% was confirmed as an independent predictor of bleeding risk at platelet counts 10 × 1e09/l in patients with ITP.
Single centre, retrospective, chart review (bleeding symptoms collected based on what was documented in chart), management of ITP not standardized (physician dependent if treatment provided or not thus potentially influencing bleeding symptoms), no blinding when assigning bleeding scores.
IPF measurement may have utility in diagnosis of ITP. In addition, IPF may be useful for prediction of relative future risk of bleeding in ITP patients, however there are limitations with the bleeding scores in this study.

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