Latest technique of ipf (immature platelet fraction) testing in dengue patients with low platelet count evaluated by hematology department at SGRH shows positive results :
- Cost of treatment for seriously ill dengue patient with low platelet count will reduce significantly
- Platelet transfusion related hazards can be avoided
- Increasing ipf percentage will help predict the time period in which platelets will increase on its own witout platelet transfusion
- Low ipf percentage will predict further fall of platelet count and the need for immediate platelet transfusion
- Sgrh found ipf as a important parameter to predict platelet recovery so that platelet transfusion can be avoided
Dengue is a mosquito borne viral infection with potential fatal complications . In this season of Dengue , we at Sir Ganga Ram Hospital have seen more than 500 confirmed cases of Dengue in OPD and admitted more than 300 cases in the hospital .
The main haematological abnormalities in dengue are thrombocytopenia and leucopenia. Thrombocytopenia is often symptomatic demanding platelet transfusion. As there is inherent risk associated with platelet transfusion , it is imperative to define precise criteria and transfusion trigger for platelets in Dengue patients .Immature platelets are recently released young platelets from bone marrow of dengue patients . The Immature Platelet Fraction (IPF %) is raised in diseases where there is increased platelet destruction and consumption , as it happens in case of dengue patients. It is decreased in bone marrow failure . The IPF % can predict the timing of platelet recovery .
According to Dr Jyoti Kotwal , Chairperson , Department of Haematology and Clinical Pathology , Sir Ganga Ram Hospital , “We have used this diagnostic modality in the paediatric patients of Dengue this season . We found that range of normal IPF at SGRH using 100 normal individuals is 0 to 7.25 % . Thus if IPF % is more than 7.25 % , it means younger re-generating platelets are present and once it crosses 10 % , it is likely that platelets will increase over next few hours . “
According to Dr Dhiren Gupta , Senior Consultant , Paediatric Intensive Care , Sir Ganga Ram Hospital , “As per the present WHO guidelines platelet transfusion is not indicated in a stable dengue patients even if platelet count is less than 10000 . With the availability of new parameter like IPF , very likely that we can predict rise in platelets in a given dengue patients . This parameter has helped us in avoiding un-necessary platelet transfusion in few paediatric dengue patients . This is an upcoming marker which can be further developed .”
In one of the studies done on IPF , it was observed that 93.75 % of patients show platelet recovery within 24-48 hours if the IPF was greater than 10 % ( Int J Lab Hematol. 2014 Oct;36(5);499-504 Evaluation of the immature platelet fraction as an indicator of platelet recovery in dengue patients)
Dr Jyoti Kotwal added , “Dengue season calls for platelet transfusion , sometimes inappropriate also . Careful clinical watchand monitoring platelet count may help to group the patients under risk category. Immature Platelet Fraction is a parameter that can be monitored to predict platelet recovery , so that platelet transfusion can be avoided , cost be saved and also the hazards associated with transfusion can also be avoided .It holds a great promise of becoming a reliable future guide for decisions concerning platelet transfusions”