The immature platelet fraction, a predictive tool for early recovery from dengue-related thrombocytopenia: a prospective study

Abstract

Background There is a paucity of predictive factors for early recovery from thrombocytopenia related to dengue. The immature platelet fraction (IPF%) is reflective of megakaryopoiesis and may correlate with recovery from dengue-related thrombocytopenia. Our objective was to assess the predictive value of IPF% on days 2 and 3 of illness for recovery from dengue-related thrombocytopenia. Methods A prospective study was conducted among patients with dengue admitted to our institution (Nawaloka Hospital PLC) from December 2019 to October 2020. Dengue was diagnosed based on positive non-structural antigen 1 or IgM. IPF% data were extracted from the Sysmex-XN-1000 automated hematology analyzer. Clinical data were obtained from electronic medical records. Statistical analyses were performed using SPSS version 20. Results We included 240 patients. An IPF% on day 2 of illness of >7.15% had a sensitivity of 80.0% and specificity of 70.4% for prediction of platelet recovery (defined as platelet count ≥60×109/L) on day 7 of illness. An IPF% of >7.25% on day 3 of illness had a sensitivity of 88.9% and specificity of 47.1% for predicting platelet recovery >60×109/L on day 8 of illness. The IPF% was significantly lower in patients with severe dengue. Platelet recovery was observed within 48 h after the peak IPF% was reached, regardless of severity. Conclusion We propose that IPF% values on days 2 and 3 of illness are a promising predictive tool for early recovery from dengue-related thrombocytopenia.

Risk and predictive factors for severe dengue infection: A systematic review and meta-analysis

“…As the whole blood counts were dynamic throughout the pathogenic process, a subgroup analysis of sampling time was conducted, but the pooled effect showed no significant difference. Additionally, some studies revealed that atypical lymphocyte count, immature platelet fraction and triple positivity for NS1, Ig M and Ig G would be predictive for SD [56][57][58], although them couldn't be included in this meta-analysis. Further studies should be performed to identify in the future.…”

Immuno-Haematologic Aspects of Dengue Infection: Biologic Insights and Clinical Implications

“…The fact that the immature platelet fraction (a surrogate for thrombopoiesis) in the peripheral blood is significantly lower in patients with severe dengue supports this hypothesis. [38] This is however difficult to study definitively, as bone marrow aspiration/biopsy is rarely performed in patients with Dengue infection. A variety of clinical parameters have been proposed which may enable early identification of patients who are likely to develop severe thrombocytopaenia.…”

“…Within 48hours after the peak IPF % was reached, platelet recovery was observed regardless of severity. [100] The increased risk of adverse outcomes with secondary dengue infection is well documented. Indeed , there is a correlation between the serologic subtype of dengue and various haematologic parameters.…”

Integrating Routine Hematological and Extended Inflammatory Parameters as a Novel Approach for Timely Diagnosis and Prognosis in Sepsis Management

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