The Utility of Immature Platelet Fraction Monitoring During a Case of Life-Threatening ITP Predicted Haemorrhagic Risk

Abstract

A severe case of immune thrombocytopenia purpura ITP presented with life threatening bleeding. Despite first line steroids and intravenous immunoglobulin IVIg this patient continued to deteriorate requiring full dose elthrombopag, romiplostim, cyclophosphamide, anti D, mycophenolate mofetil MMF, 31 units of platelets and 14 units of packed red cells. It took 3 weeks before the platelets responded, and the patient went on to make a full functional recovery despite severe pulmonary haemorrhages and a pneumothorax. Immature platelet fraction IPF measurements are now more readily available given the ability of high-end full blood count analysers to perform them. A high IPF percentage would correlate with increased megakaryopoiesis in the bone marrow. When combined with a thrombocytopenia it would favour a consumptive process like ITP as the underlying aetiology. In this case IPF was monitored concurrently with the absolute platelet count. Interestingly when the IPF fell during their admission the patient demonstrated overt bleeding. If the bleeding phenotype can be more accurately risk stratified this could help the clinician identify lower risk patients allow them to be managed in an outpatient setting. A larger study of ITP patients is required with IPF measurements to see if a robust risk stratification is possible.