Comparison of Immature Platelet Fraction (IPF) in Patients with Central Thrombocytopenia and Peripheral Thrombocytopenia

Objective: To determine immature platelet fraction (IPF) in patients with thrombocytopenia and correlation with their bone marrow findings and to determine its predictive value in differentiating peripheral (hyper destructive) thrombocytopenia from central (hypo-productive) thrombocytopenia. Study Design: Cross-sectional comparative study. Place and Duration of Study: King Edward Medical University (KEMU) and Doctors Hospital Lahore, from December 2018 to February 2019. Methodology: Patients of both genders and all age groups with thrombocytopenia presenting for bone marrow biopsy were included in the study. Clinical data, complete blood count (CBC) sample in EDTA, bone marrow aspirate and trephine biopsy were obtained. Slides were prepared and reviewed. CBC sample was analysed for counts and IPF in Doctors Hospital Laboratory within 4 hours of collection. Results: According to bone marrow findings, patients were grouped under two categories; Group 1 with central (hypo-productive group) thrombocytopenia and Group 2 with peripheral (hyper-destructive group). Group1 (n=44) showed median interquartile range (IQR) IPF 8.2 (4.6-16.7), which was significantly lower (p <0.001) than that of Group 2 (n=14) in which Median IQR IPF was 25.5 (15.2-39.3). A significant moderate degree negative (inverse) correlation was observed between platelet counts and IPF in thrombocytopenic patients in both groups by Pearson correlation. It was statistically significant at p <0.001 level. IPF in hyper-destructive group has 100% predictive value compared to 31% in hypo-productive group. Conclusion: IPF is a useful parameter and can reliably identify patients having thrombocytopenia due to peripheral destruction. In other cases, IPF should be used in conjunction with other investigations like bone marrow biopsy etc.