Abstract
Objectives: Reticulated platelets circulating in the blood reflect megakaryopoietic activity and platelet turnover and can be automatically and low-invasively measured as the immature platelet fraction (IPF) using a Sysmex XN hematocytometer. The present study retrospectively investigated whether or not the IPF can predict the treatment response to corticosteroids in adult patients with primary immune thrombocytopenia (ITP). Methods: Forty-six patients who had been newly diagnosed with primary treatment-naïve ITP and started treatment with corticosteroids were analyzed. Results: Among the 46 primary ITP patients, 33 (72%) responded to the treatment and 13 (28%) did not. The percentage of IPF (IPF%) among the nonresponders was significantly lower than that of the responders (6.6 vs. 16.0%; p < 0.001). In the receiver operating characteristics analysis, the optimum IPF% cut-off value for predicting the treatment response was 12%, with a specificity of 85% and a sensitivity of 76%. Conclusions: Our findings thus suggest that measuring the IPF% as a surrogate of reticulated platelets is useful to identify patients likely to respond to corticosteroids.
References
1.
Newland
A
, Bentley
R
, Jakubowska
A
, Liebman
H
, Lorens
J
, Peck-Radosavljevic
M
, et al A systematic literature review on the use of platelet transfusions in patients with thrombocytopenia
. Hematology
. 2019
Dec
;24
(1
):679
–719
.
[PubMed]
1607-84542.
Provan
D
, Arnold
DM
, Bussel
JB
, Chong
BH
, Cooper
N
, Gernsheimer
T
, et al Updated international consensus report on the investigation and management of primary immune thrombocytopenia
. Blood Adv
. 2019
Nov
;3
(22
):3780
–817
.
[PubMed]
2473-95293.
Briggs
C
, Kunka
S
, Hart
D
, Oguni
S
, Machin
SJ
. Assessment of an immature platelet fraction (IPF) in peripheral thrombocytopenia
. Br J Haematol
. 2004
Jul
;126
(1
):93
–9
.
[PubMed]
0007-10484.
Koike
Y
, Miyazaki
K
, Higashihara
M
, Kimura
E
, Jona
M
, Uchihashi
K
, et al Clinical significance of detection of immature platelets: comparison between percentage of reticulated platelets as detected by flow cytometry and immature platelet fraction as detected by automated measurement
. Eur J Haematol
. 2010
Feb
;84
(2
):183
–4
.
[PubMed]
0902-44415.
Kurahashi
H
, Takami
A
, Murotani
K
, Numoto
S
, Okumura
A
. Decreased platelet count in children with epilepsy treated with valproate and its relationship to the immature platelet fraction
. Int J Hematol
. 2018
Jan
;107
(1
):105
–11
.
[PubMed]
0925-57106.
Sugimori
N
, Kondo
Y
, Shibayama
M
, Omote
M
, Takami
A
, Sugimori
C
, et al Aberrant increase in the immature platelet fraction in patients with myelodysplastic syndrome: a marker of karyotypic abnormalities associated with poor prognosis
. Eur J Haematol
. 2009
Jan
;82
(1
):54
–60
.
[PubMed]
0902-44417.
Takami
A
, Shibayama
M
, Orito
M
, Omote
M
, Okumura
H
, Yamashita
T
, et al Immature platelet fraction for prediction of platelet engraftment after allogeneic stem cell transplantation
. Bone Marrow Transplant
. 2007
Apr
;39
(8
):501
–7
.
[PubMed]
0268-33698.
Hoffmann
JJ
. Reticulated platelets: analytical aspects and clinical utility
. Clin Chem Lab Med
. 2014
Aug
;52
(8
):1107
–17
.
[PubMed]
1434-66219.
Rodeghiero
F
, Stasi
R
, Gernsheimer
T
, Michel
M
, Provan
D
, Arnold
DM
, et al Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group
. Blood
. 2009
Mar
;113
(11
):2386
–93
.
[PubMed]
0006-497110.
Ebaugh
FG
Jr, Bird
RM
. The normal megakaryocyte concentration in aspirated human bone marrow
. Blood
. 1951
Jan
;6
(1
):75
–80
.
[PubMed]
0006-497111.
Tomiyama
Y
, Miyakawa
Y
, Okamoto
S
, Katsutani
S
, Kimura
A
, Okoshi
Y
, et al A lower starting dose of eltrombopag is efficacious in Japanese patients with previously treated chronic immune thrombocytopenia
. J Thromb Haemost
. 2012
May
;10
(5
):799
–806
.
[PubMed]
1538-793312.
Bussel
JB
, Kuter
DJ
, George
JN
, McMillan
R
, Aledort
LM
, Conklin
GT
, et al AMG 531, a thrombopoiesis-stimulating protein, for chronic ITP
. N Engl J Med
. 2006
Oct
;355
(16
):1672
–81
.
[PubMed]
0028-479313.
Shirasugi
Y
, Ando
K
, Miyazaki
K
, Tomiyama
Y
, Iwato
K
, Okamoto
S
, et al An open-label extension study evaluating the safety and efficacy of romiplostim for up to 3.5 years in thrombocytopenic Japanese patients with immune thrombocytopenic purpura (ITP)
. Int J Hematol
. 2012
Jun
;95
(6
):652
–9
.
[PubMed]
0925-571014.
Bussel
JB
, Provan
D
, Shamsi
T
, Cheng
G
, Psaila
B
, Kovaleva
L
, et al Effect of eltrombopag on platelet counts and bleeding during treatment of chronic idiopathic thrombocytopenic purpura: a randomised, double-blind, placebo-controlled trial
. Lancet
. 2009
Feb
;373
(9664
):641
–8
.
[PubMed]
0140-673615.
16.
Ferreira
FL
, Colella
MP
, Medina
SD
, Fiusa
MM
, da Costa
LN
, Costa-Lima
C
, et al Differential Diagnosis of Hereditary and Acquired Thrombocytopenia By the Immature Platelet Fraction and Thrombopoietin Levels
. Blood
. 2015
;126
(23
):1049
–1049
. 0006-497117.
Hong
KH
, Kim
HK
, Kim
JE
, Jung
JS
, Han
KS
, Cho
HI
. Prognostic value of immature platelet fraction and plasma thrombopoietin in disseminated intravascular coagulation
. Blood Coagul Fibrinolysis
. 2009
Sep
;20
(6
):409
–14
.
[PubMed]
0957-523518.
Yujiri
T
, Tanaka
Y
, Tanaka
M
, Tanizawa
Y
. Fluctuations in thrombopoietin, immature platelet fraction, and glycocalicin levels in a patient with cyclic thrombocytopenia
. Int J Hematol
. 2009
Oct
;90
(3
):429
–30
.
[PubMed]
0925-571019.
Nakao
S
, Gale
RP
. Are mild/moderate acquired idiopathic aplastic anaemia and low-risk myelodysplastic syndrome one or two diseases or both and how should it/they be treated?
Leukemia
. 2016
Nov
;30
(11
):2127
–30
.
[PubMed]
0887-692420.
Seiki
Y
, Sasaki
Y
, Hosokawa
K
, Saito
C
, Sugimori
N
, Yamazaki
H
, et al Increased plasma thrombopoietin levels in patients with myelodysplastic syndrome: a reliable marker for a benign subset of bone marrow failure
. Haematologica
. 2013
Jun
;98
(6
):901
–7
.
[PubMed]
0390-607821.
Saito
C
, Ishiyama
K
, Yamazaki
H
, Zaimoku
Y
, Nakao
S
. Hypomegakaryocytic thrombocytopenia (HMT): an immune-mediated bone marrow failure characterized by an increased number of PNH-phenotype cells and high plasma thrombopoietin levels
. Br J Haematol
. 2016
Oct
;175
(2
):246
–51
.
[PubMed]
0007-104822.
Cybulska
A
, Meintker
L
, Ringwald
J
, Krause
SW
. Measurements of immature platelets with haematology analysers are of limited value to separate immune thrombocytopenia from bone marrow failure
. Br J Haematol
. 2017
May
;177
(4
):612
–9
.
[PubMed]
0007-104823.
Gonzalez-Porras
JR
, Martin-Herrero
F
, Gonzalez-Lopez
TJ
, Olazabal
J
, Diez-Campelo
M
, Pabon
P
, et al The role of immature platelet fraction in acute coronary syndrome
. Thromb Haemost
. 2010
Jan
;103
(1
):247
–9
.
[PubMed]
0340-624524.
Panova-Noeva
M
, Marchetti
M
, Buoro
S
, Russo
L
, Leuzzi
A
, Finazzi
G
, et al JAK2V617F mutation and hydroxyurea treatment as determinants of immature platelet parameters in essential thrombocythemia and polycythemia vera patients
. Blood
. 2011
Sep
;118
(9
):2599
–601
.
[PubMed]
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