Etiological Potential of Immature Platelet

Fraction in Children with Thrombocytopenia

Dr. Aishwarya Chezhian
Junior Resident, Department of Paediatrics
Kasturba Medical College, Manipal.

Under the guidance of

Dr. Sandesh Kini

Associate professor, Department of Paediatrics,
Kasturba Medica College, Manipal.

Dr. Vasudeva Bhat K

Associate Professor, Department of Pediatrics Hematology and Oncology,
Deputy Coordinator, Manipal Comprehensive Cancer Care Centre
Kasturba Medical College , Manipal
INTRODUCTION
• Thrombocytopenia is a finding that is common to a number of
underlying conditions1-4
• The assessment of bone marrow thrombopoietic activity in patients
with thrombocytopenia is necessary to achieve an accurate diagnosis
and administer effective Treatment5
• Immature platelets can be useful marker of thrombopoietic
activity5.They represent the most recently produced platelets released
into the circulation by regenerated bone marrow megakaryocytes.
DEFINITION
• Thrombocytopenia is defined as a count less than 1,50,000 platelets
per microlitre6
• Immature Platelet are those which are released from the bone
marrow which contains small amounts of RNA within the cytoplasm
and are more reactive than mature platelets7
• The number of circulating immature platelets reflects the rate of
thrombopoiesis and bone marrow function and, as such, may be
useful in the determination of thrombocytopenic etiology8
 CAUSES OF THROMBOCYTOPENIA
Decreased Production
Hypoplasia of megakaryocytes
Ineffective thrombopoiesis
Hereditary thrombocytopenia
Disorders of thrombopoietic control
10
Increased Consumption/destruction Abnormal platelet distribution or
pooling
Autoimmune- Disorders of spleen-
Primary: Idiopathic neoplastic,congestive,infiltrative,infec
Secondary :lymphoproliferative tions
disorders, drugs, collagen vascular
disorders.
Alloimmune- Hypothermia
Neonatal thrombocytopenia, post
transfusion purpura
Non-immunological- Dilution of platelets with massive
Thrombotic thrombocytopenic transfusions
purpura,hemolytic uremic syndrome,
disseminated intravascular
coagulation
Infections,massive blood transfusions
AIM
• To correlate immature platelet fraction in children with
thrombocytopenia to evaluate its potential as an etiological
determinant.
OBJECTIVE
• To evaluate immature platelet fraction in children with
thrombocytopenia.
• To correlate the levels of immature platelet fraction in different
etiologies of thrombocytopenia.
• To correlate the bleeding assessment score/Bleeding severity score
MATERIALS AND METHODS
• Study Design: Prospective, single centre, case control study.
• Study Setting: Department of Paediatrics and Department of
Paediatric Haematology and oncology, Kasturba Medical College,
Manipal.
• Study Period: July 2023 to April 2025
• Sample Size: Case-100
Control-200
STUDY POPULATION
• Cases: Children from 1month to 18years with thrombocytopenia who
are admitted in Department of Paediatrics and Department of
Paediatric Haematology and oncology, Kasturba Medical College,
Manipal.

• Controls: Children from 1month to 18years who are admitted in

Department of Paediatrics and Department of Paediatric
Haematology and oncology, Kasturba Medical College, Manipal.
INCLUSION CRITERIA
• Cases: Children from 1month to 18years of age with
thrombocytopenia having Platelet count of less than 50,000 per
microlitre.

• Controls: Children from 1month to 18years of age with platelet counts

within normal limits 1,50,000/microlitre to 4,50,000/microlitre
EXCLUSION CRITERIA
• Haematological malignancies(leukemia,lymphoma) on treatment
• Children on cytotoxic drugs/ radiation therapy.
• Children previously diagnosed of idiopathic thrombocytopenic
purpura, thrombotic thrombocytopenic purpura, aplastic anemia on
disease specific treatment.
• Children who had received platelet transfusion within the last 7 days.
METHODOLOGY
• Ethics clearance -Study protocol will be reviewed by ethics committee
of the institution for approval.
• Cases will be selected after application of inclusion and exclusion
criteria.
• Informed consent will be obtained from the parents of study
participants after explaining about the purpose and relevance of
study in the regional language and providing the patient information
sheet.
• Detailed history and clinical examination will be done and findings will
be entered in the pre-designed proforma.
• The blood sample collected during admission for evaluation purpose
will be used for estimation of Immature platelet fraction in all the
children included in the study.
• Method: Flowcytometry using Optical Fluorescence Method.
STATISTICAL ANALYSIS
• Data will be analyzed using IBM SPSS Statistics 23. Descriptive data
will be expressed as percentage, median and interquartile range or as
mean and standard deviation.
PROFORMA
CASE/CONTROL
Serial number:
Hospital number : IP number:
Unit :
Date of examination :
Age in months : Date of birth:
Gender :
Address :
History of presenting symptoms
1)Fever - yes/no
2)Rash – yes/no
3)Increased Bleeding tendencies:
Abnormal prolonged bleeding- yes/no
Bleeding from normal sites- yes/no
Bleeding from gums -yes/no
Hematuria - yes/no
jaundice- yes/no
edema -yes/no
nausea/vomiting - yes/no
diarrhoea -yes/no
11
Treatment history
History of platelet transfusions -yes/no; If Yes how many days prior ___
Any usage immunosuppressant dugs -yes/no
• Past history
• if yes details-
• H/o antiepileptic drugs- yes/ no
• History of previous medications -
• Birth history -
• Development history -
• Immunization history – In the last 8 weeks: Yes/NO
• Family history
- History of hematological malignancies in family
- History of any autoimmune disorders
- History of thrombocytopenia/bleeding
• General examination
Anthropometry
Weight -
Height -
Head circumference-
• Any visible bleeding sites
• Skin bleeds: Yes/No, If yespupura,ecchymosis
• Mucosal bleeds: Yes/No
• Deep bleeds: Yes/Nohematomas/organ bleeds

• Stigma of IBMFS:
• Nail changes
• Skeletal abnormality
• Skin pigmentary changes
Local examination
• Anemia : Yes/No
• Lymphadenopathy: Yes/No… IF yes Generalized : Yes/No
Systemic examination
• Cardiovascular system -

• Respiratory system-

• Per abdomen-
• Liver
• Spleen
• Central nervous system-
 INVESTIGATION
• Hemoglobin
• Hematocrit
• RBC indices –MCV:
MCH:
MCHC:
RDW:

• WBC count
• Differential count: Neutrophils
lymphocytes:
Monocytes
Eosinophils:
Basophils:
• Platelet count
• MPV
• PDW
• PCT
• Immature platelet fraction
• Peripheral smear findings
• Large platelet
• Small platelet
• Presence of blasts
• Hypersegmented Neutrophils
Diagnostic investigation (If done)
• Infective Dengue/malaria/etc
• Nutritional profile- B12 and folate
• Autoimmune panel
• Bone marrow examination
• Flow cytometry
• Others
 REVIEW OF LITERATURE
Article and Study type and Inclusion Sample size Study done at and
year
Parameters Result
author method criteria evaluated

Immature Prospective Patients with A total of 637 Hematology Platelet count The IPF was
platelet cohort study platelet count patients were Department, and immature significantly
fraction as <1,40,000/l identified as Airedale General platelet higher in cases
Hospital,
useful marker patients were thrombocytop Steeton, UK; b fraction. of increased
in the accepted into enic Centre for platelet
etiological the study, and Bioscience, consumption
determination patients with Manchester compared with
of history of Metropolitan controls.
thrombocytop platelet University,
enia transfusion<30 Manchester, UK;
-Ali I,Graham days were c School of
Biological
C,et al excluded from Sciences,
the study. Queen’s
University
Belfast, UK in the
year 2019.
Article and Study type and Inclusion Sample size Study done at Parameters Result
author method criteria and year included

Immature Prospective Patients with 105 controls Patients Platelet IPF is higher in
platelet case control Thrombocytop and 62 cases. treated at the counts,Platelet Hyper
fraction a study enia, aplastic Hallym crit,IPF,AIPC,PD destructive
useful marker anaemia and University W,MPV,P-LCR. thrombocytop
for identifying ongoing Sacred enia compared
the cause of chemotherapy Hospital, to control
thrombocytop patients as Anyang, group.
enia and cases and Republic of
predicting healthy Korea between
platelet individuals as January 2016
recovery controls. to July 2018.
Jeon K,Kim M
et al
Article and Study type Inclusion criteria Sample size Study done at Parameters Result
author and method and year included

Immature Prospective Patients with 61 as cases Patients Immature IPF is higher in

Platelet case control platelet count and 101 as treated in platelet the patients
Fraction: Its study less than controls AIIMS ,Bhopal fraction with
Clinical Utility 1,00,000 as and L.N hyperdesctruc
in cases and medical tive
Thrombocytop controls as college thrombocytop
enia Patients people with Bhopal,madhy enia
Goel G,Senwal platelet count apradesh in
S et al 1,50,000 to the year 2021.
4,50,000.
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REFERENCES
• 6. Ali I, Graham C, Dempsey-Hibbert NC. Immature platelet fraction as a useful marker
in the etiological determination of thrombocytopenia. Exp Hematol. 2019 Oct;78:56-
61. doi: 10.1016/j.exphem.2019.09.001. Epub 2019 Sep 24. PMID: 31560930.
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10.1097/MD.0000000000019096. PMID: 32049816; PMCID: PMC7035018.

• 8. Jung H, Jeon HK, Kim HJ, Kim SH. Immature platelet fraction: establishment of a
reference interval and diagnostic measure for thrombocytopenia. Korean J Lab Med.
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• 9.Goel G, Semwal S, Khare A, Joshi D, Amerneni CK, Pakhare A,
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Thrombocytopenia Patients. J Lab Physicians. 2021
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15. PMID: 34602784; PMCID: PMC8478497.
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• 11.Grading of hemorrhage in children with idiopathic
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