Circulating immature platelets, also known as the immature platelet fraction (IPF), is the term that defines much larger platelets that have been recently released from the bone marrow, presence of which show the thrombopoietic activity of the marrow.
They represent the most recently produced platelets released into the circulation by regenerated BM megakaryocytes. These types of platelets are the analogs of reticulocytes and are similarly large; moreover, they contain elevated amounts of cytoplasmic RNA and decrease in size and RNA content as they age. The number and proportion of immature platelets reflect the rate of thrombopoiesis; the values of these parameters rise and fall concomitantly with the platelet production rate.
It can help to distinguish between causes of thrombocytopenia due to:
→ Increased consumption/destruction (ITP) - High IPF
→ Decreased production (marrow failure) – Low IPF
→ It predicts the timing of platelet recovery (in Dengue, Malaria, after transplantation or chemotherapy)
→ It can save platelet transfusions: Help to save a precious resource and help to avoid potential infection risk.
→ IPF estimation can be used as guide for decisions concerning platelet transfusions & recovery of platelets in patients with Dengue, Malaria, etc.
→ The IPF% can predict the timing of platelet recovery. The platelet recovery time is 1-2 days of IPF increase.
→ It was found that when the IPF starts going up (rising trend), 93.75% of the patients showed recovery within 24–48 h of the rise. After a certain point when the IPF has peaked, then the platelets start coming up and IPF starts falling. This fall in the
→ IPF is a strong predictor of an impending rise in platelet count.
→ As on most clinical scenarios follow-up IPF data for patients is not available, it has been shown in various studies that use of a single time point IPF with cut-off value of 10% and above can be considered a good predictor for platelet recovery.
References:
Jeon K, Kim M, Lee J, Lee JS, Kim HS, Kang HJ, Lee YK. Immature platelet fraction: A useful marker for identifying the cause of thrombocytopenia and predicting platelet recovery. Medicine. 2020 99 7(e19096). [L]
Kickler TS, Oguni S, Borowitz MJ. Clinical evaluation of high fluorescent platelet fraction percentage in thrombocytopenia. Am J Clin Pathology 2006 125 282 287. [L]
Immature Platelet Fraction
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