Immature Platelet Fraction Levels Research Articles

Correlation between staging classification of aortic stenosis based on the extent of cardiac damage and platelet indices

BackgroundPlatelets play a key role in the natural history of aortic stenosis (AS) and after transcatheter aortic valve implantation (TAVI). An echo-based staging system stratifies patients with severe AS into 5 groups according to the associated cardiac damage phenotype. We aimed to correlate these AS stages with platelet indices in post-TAVI patients.MethodsPatients with severe AS who underwent TAVI and were admitted to intensive cardiac care unit (ICCU) were prospectively identified and divided into 5 groups according to extra-valvular cardiac damage [no extravalvular cardiac damage (Stage 0), left ventricular damage (Stage 1), left atrial or mitral valve damage (Stage 2), pulmonary vasculature or tricuspid valve damage (Stage 3), or right ventricular damage (Stage 4)]. Baseline characteristics and complete blood count including mean platelet volume (MPV) and immature platelet fraction (IPF) were collected within 2 h after the procedure and analyzed in relation to aortic stenosis staging.ResultsA total of 220 patients were included. The mean age was 81 years old and 112 (50.9%) were female. Two (1%) patients were classified in stage 0; 34 (15%) in stage 1; 48 (22%) in stage 2; 49 (22%) in stage 3 and 87 (40%) in stage 4. Higher mean MPV values were correlated with higher AS staging (10.8 fL, 11 fL, 11.3 fL and 10.8 fL in stages 1, 2, 3 and 4, respectively, P = 0.02) as well as lower hemoglobin values (12 mg/dl, 11.6 mg/dl, 11 mg/dl and 11.3 mg/dl in stages 1, 2, 3 and 4, respectively P = 0.04). Mean IPF values were 5.3%, 5.58%, 5.57% and 4.83% in stage 1, 2, 3 and 4, respectively (P = 0.4). In a multivariate logistic regression model only MPV (OR = 2.6, P = 0.03) and body mass index (BMI) (OR = 1.17, P = 0.004) were correlated with higher staging (0–3) of AS.ConclusionsAlthough IPF and MPV levels increased in stages 0–3, there was a decrease in indices in stage 4, (probably due to bone marrow dysfunction) in this end-stage population. Higher levels of MPV and lower levels of hemoglobin were independently correlated with higher stages (0–3) of AS.

Immature platelet fraction levels predict the development of prolonged thrombocytopenia after haematopoietic stem cell transplantation

Prolonged thrombocytopenia (PT) is a serious complication after haematopoietic stem cell transplantation (HSCT). PT has been suggested to be associated with an increased platelet transfusion requirement and poor outcomes after transplantation. Due to the complex mechanism of PT development, it is difficult to diagnose in the early post-transplant period. Our study aimed to identify an early predictive marker for PT after HSCT. Previous studies showed that the clinical utility of immature platelet fraction (IPF) predicts platelet recovery after chemotherapy and successful engraftment. However, the relationship between IPF and PT after HSCT remains unclear. Fifty-two patients with malignant haematological diseases who underwent HSCT were included in the study. We observed the kinetics of recovery of haematological parameters after transplantation and performed receiver operating characteristics (ROC) curve analysis using data from the 52 HSCT patients. The days to rise and peak of IPF, absolute IPF count (A-IPF) and highly fluorescent IPF (H-IPF) were almost synchronised in all patients, at day 10 and day 15, respectively. The begin to rise levels of IPF, H-IPF and A-IPF were all significantly lower in the PT group than in the good engraftment (GE) group (p=0.0016, p=0.0094, p=0.0086, respectively). The peak levels of IPF were significantly lower in the PT group than the GE group (p=0.0036). However, the peaks of H-IPF and A-IPF were not statistically significant between the two groups (p=0.3383, p=0.0887, respectively). The area under the ROC curve (AUC) of IPF rise was 0.739 (95% CI 0.583-0.896; p<0.05) and the cut-off value was 3.5%, while the AUC of IPF peak was 0.800 (95% CI 0.637-0.962; p<0.01) and the cut-off value was 8.0%. In conclusion, early low levels of IPF predict the development of PT after HSCT. These findings may help improve the management and treatment strategies for PT after HSCT.

Study of Immature Platelet Fraction, Mean Platelet Volume and Interleukin-6 in Acute Coronary Syndrome: A Study at a Tertiary Care Hospital in India

Background In the pathophysiology of acute coronary syndrome (ACS), platelets play a key role. The immature platelet fraction (IPF) is thought to be a possible indicator of activation of platelets and turnover processes. Younger platelets have a higher thrombotic potential and combine with collagen faster, which might compromise their ability to maintain hemostasis and lead to the development of thrombus. MPV measurements show platelet activation. IL-6 plasma levels seem to indicate the degree of latent plaque inflammation and, thus, may indicate susceptibility to plaque rupture. Aims and Objectives To estimate the levels of IPF, MPV and IL-6 in ACS and to find out the association and correlation of IPF, MPV and IL-6 with ACS. Material and Method Seventy patients of ACS fitting the Universal criteria of Myocardial infarction as cases and 70 healthy controls were included in the study. MPV, IPF, and IL6 were analyzed in all the cases and controls using various statistical tools. Result MPV (fl) was the best predictor among all parameters at a cutoff point of &gt;4.2, with an AUC of 0.855 for correctly predicting STEMI. IPF came out to be a reasonably good marker for predicting STEMI, with a mean of 8.71 ± 5.39. IL-6 in NSTEMI was significantly higher than in controls ( P = .004) and was comparable with UA ( P = .09). Conclusion The current study’s findings seem to confirm that elevated MPV and IPF are important ancillary indicators in the assessment of ACS.

Immature Platelet Fraction and Acute Coronary Syndrome; a Systematic Review and Meta-Analysis.

Immature Platelet Fraction (IPF) is a measure of the proportion of reticulated platelets (RPs) to all platelets in circulation. IPF may have both prognostic and diagnostic values in patients with Acute Coronary Syndrome (ACS). This study aims to comprehensively summarize the diagnostic utility of IPF levels in patients with ACS, specifically focusing on its ability to differentiate between different subtypes of ACS. We conducted a systematic search in online databases including MEDLINE, Scopus, and Google Scholar up to March 4th 2024, to identify relevant studies. The random-effect model, employing inverse variance for mean differences (MD) and Mantel-Haenszel methods for odds ratios (OR) were utilized to combine the data. Joanna Briggs Institute (JBI) appraisal tool was employed to assess the quality of included studies. Our systematic review contains 15 articles with a total sample size of 2,030 ACS patients. Pooled analysis revealed significant differences in IPF levels of ACS patients compared to healthy controls (MD (95%CI): 2.85 (0.86, 4.85), P-value = 0.004) and stable angina patients (MD (95%CI): 0.58 (0.23, 0.92), P-value < 0.001). Subgroup comparisons within ACS patients demonstrated higher IPF levels in myocardial infarction (MI) vs. unstable angina (UA) (MD (95%CI): 1.81 (0.41, 3.22), P-value = 0.01), ST elevation MI (STEMI) vs. non-ST elevation (NSTEMI) ACS (MD (95%CI): 0.74 (0.31, 1.17), P-value < 0.001), and NSTEMI vs. UA (MD (95% CI): 1.07 (0.24, 1.90), P-value = 0.01). IPF levels could increase in patients with ACS, particularly during the acute phase of STEMI. This suggests that IPF may be a useful biomarker for early diagnosis of ACS. Additionally, IPF levels may help differentiate between ACS subtypes.

Towards a greater understanding of reduced response to aspirin in children with congenital heart disease post-cardiac surgery using immature platelet fraction

ObjectiveA high platelet turnover rate may produce a population of platelets that confers an inadequate response to aspirin. We aimed to investigate the relationship between residual platelet aggregation and platelet turnover in paediatric cardiology patients on aspirin monotherapy by evaluating the fraction of immature platelets as a marker for turnover and secondly to test the predictive value of the immature platelet fraction (IPF) to classify patients as responsive or non-responsive to aspirin. MethodsSixty patients divided into two age categories (≤90 days, >90 days of age) were included in this prospective observational study. Patients were then stratified into tertiles using their IPF level. Platelet studies included thromboelastography with platelet mapping (TEGPM). ResultsThe overall incidence of ‘inadequate response to aspirin’ was 38 % in our patient cohort recently post-cardiac surgery a consequence that warrants further study. The frequency of inadequate response to aspirin was higher in the upper tertile of IPF when compared to the lower tertile, (88 %) versus (4 %) respectively (p < 0.05). The ‘cut off’ for IPF was determined to be 3.9 % with a sensitivity of 95.7 %, and a specificity of 92.9 % (area under the curve of 0.955 [CI 0.896–1.014, p < 0.05]). ConclusionThis study demonstrates that inadequate response to aspirin occurs in approximately 38 % of patients undergoing specific high-risk congenital cardiac procedures using the dosing practice of a national centre. This study supports the hypothesis that an elevated platelet turnover may result in aspirin being less effective in patients who are recently post cardiac surgery. These data are of direct translational relevance.

Platelet Count Response to Obstetrical Use of IVIG for Maternal Thrombocytopenia: A 14-Year Retrospective Study

Introduction: Thrombocytopenia affects approximately 10% of pregnant individuals with Gestational Thrombocytopenia (GT) accounting for 80% of cases and Immune Thrombocytopenia (ITP) representing 3% of cases. Distinguishing between GT and ITP is challenging, leading to many pregnant individuals with moderate thrombocytopenia receiving treatment for ‘possible ITP’ with Intravenous Immunoglobulin (IVIG) in attempt to raise platelet counts (PLT) for safe labor and delivery and to potentially allow for neuraxial anesthesia. However, evidence on the impact of IVIG on PLT during pregnancy remains limited, and predictive factors for IVIG response are lacking. We aim to investigate the effect of IVIG on PLT in pregnant individuals with moderate thrombocytopenia (PLT &amp;lt; 100 x 10 9/L). The specific objectives are to assess the incremental response in maternal PLT following IVIG administration, the proportion of PLT exceeding 80 x 10 9/L after IVIG administration, the proportion of incremental increase in PLT by more than 20 x 10 9/L following IVIG administration, and to identify factors associated with these outcomes. Methods: We conducted a retrospective cohort study using administrative and chart review data between 2007-2020. We included all pregnant individuals who received IVIG for moderate thrombocytopenia. Data collected encompassed parameters such as age, gestational age at delivery, platelet counts at various timepoints, highest immature platelet fraction (IPF) during pregnancy, IVIG dose and frequency, hemoglobin levels, transfusions, and corticosteroid use. Data were analyzed using descriptive statistics. Paired t-test was used to compare means of PLT pre- and post-IVIG administration. Simple logistic regression was used to assess predictors of PLT ≥ 80 x10 9/L and PLT increment ≥ 20 x10 9/L post-IVIG. Results: Out of 651 deliveries with moderate thrombocytopenia, 79 (12.1%) received IVIG for a total of 4,527.50 grams and a median dose of 60 g (IQR: 30 - 77.5). Excluding 22 pregnancies due to other interventions such as platelet transfusions (n=12), corticosteroids (n=7), or both (n=3), 57 remained for analysis. The median incremental response in PLT following IVIG administration was 27 x10 9/L (IQR: 3-94). Pre-IVIG PLT median was 65 x10 9/L (IQR: 48-73), and post-IVIG PLT median was 98 x10 9/L (IQR: 69-142). PLT increment ≥ 20 x 10 9/L following IVIG was observed in 54.4% (31/57) of deliveries, and 57.9% (33/57) of deliveries achieved PLT ≥ 80 x 10 9/L following IVIG administration. Mean PLT post-IVIG (M = 112.51 x10 9/L, SD 55.88) were significantly greater than pre-IVIG PLT (M = 59 x10 9/L, SD = 19.71) by 53.51 points, p = &amp;lt; .001. Nadir PLT &amp;lt; 30 in pregnancy was associated with a statistically significant increase in PLT ≥ 80 x10 9/L following IVIG (odds ratio (OR) = 6.29, 95% confidence interval (CI) = 1.25-31.51, p &amp;lt; 0.05) and PLT increment ≥ 20 x10 9/L (OR = 7.58, 95% CI = 1.51-38.05, p &amp;lt; 0.05). An IPF &amp;lt; 16% was also associated with a statistically significant increase in PLT ≥ 80 x10 9/L (OR = 4.85, 95% CI = 1.08-21.76, p &amp;lt; 0.05) and PLT increment ≥ 20 x10 9/L (OR = 4.85, 95% CI = 1.08 - 21.76, p &amp;lt; 0.05). Moreover, a post-IVIG PLT increment ≥ 20 x10 9/L was positively associated with pre-IVIG PLT below 50 x10 9/L (OR = 8.67, 95% CI = 1.73 - 43.33, p &amp;lt; 0.05), but negatively associated with PLT 70-100 x10 9/L (OR = 0.18, 95% CI = 0.05 - 0.57, p &amp;lt; 0.05). For post-IVIG PLT ≥ 80 x10 9/L, there were no statistically significant relationships with gestational age, maternal age, pre-pregnant PLT or pre-IVIG PLT. Similarly, for post-IVIG PLT increment ≥ 20 x10 9/L, there were no statistically significant relationships with GA, maternal age, pre-pregnant PLT, or a pre-IVIG PLT between 50-69 x10 9/L. Conclusions: IVIG administration shows promising results for pregnant individuals with moderate thrombocytopenia. The study highlights the importance of nadir PLT in pregnancy, IPF levels, and pre-IVIG PLT as potential factors influencing the response to IVIG treatment. Our study is limited by its retrospective and single-centered design, and small sample size. Nevertheless, these findings generate hypotheses and could inform future prospective multicenter studies to optimize IVIG administration in this setting, considering its effectiveness and potential risks while minimizing costs.

Using immature platelet fraction as a factor in deciding on the need for platelet transfusions

Our study aimed to assess the prognostic significance of immature platelet fraction (IPF) and its role in deciding whether to transfuse platelets. The study was approved by the Independent Ethics Committee and the Scientific Council of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology. We monitored this hematologic parameter in 6 patients before and after hematopoietic stem cell transplantation (HSCT). For the study, we used whole blood collected in K EDTA tubes. IPF levels were measured by flow cytometry on the automated hematology analyzer SYSMEX XE-2100 (Sysmex, Kobe, Japan). The presence of platelet antibodies was detected using Capture-P Ready-Screen solid phase system for the detection of antibodies to platelets and the NEO Blood Bank Analyzer by Immucor, Inc. It was shown that the use of IPF enabled an early establishment of platelet engraftment and helped to make more a reasoned decision regarding the transfusion of platelets. It was established that if a rise in IPF &gt; 6% was not accompanied by an increase in platelet count, serum platelet antibody testing was needed. IPF can help diagnose platelet engraftment failure following HSCT and thus eliminate the need for bone marrow aspiration. IPF is of great clinical importance; if adopted as a routine hematologic parameter, it can serve as an additional factor in deciding on the need for platelet transfusions and platelet antibody testing and subsequent personalized selection of platelets.

High Immature Platelet Fraction is Associated with Early Neurological Deterioration in Acute Ischemic Stroke (P3-5.007)

<h3>Objective:</h3> To investigate the association between the level of immature platelet fraction (IPF) and the prevalence of early neurological deterioration (END) in acute ischemic stroke patients. <h3>Background:</h3> Early neurological deterioration (END) in acute ischemic stroke is a common event. However, the underlying pathophysiological bases are heterogenous and hard to explain. Immature platelet fraction (IPF) is the useful marker of increased platelet production and turnover which could occur in patients with increased platelet activation. High value of IPF was reported in acute coronary syndrome. <h3>Design/Methods:</h3> A total 1655 of acute ischemic stroke patients in single tertiary academic center was enrolled from January 2013 to October 2018 via stroke registry. IPF levels were quantified by whole blood flow cytometry with automated assays (Sysmex XE-2100™). High IPF was defined as the IPF level was more than 5%. Early neurological deterioration was defined as an increment change of at least one point in motor power or total National Institute of Health Stroke Scale (NIHSS) score deterioration ≥2 points within the first week after admission. <h3>Results:</h3> A total of 72 patients (4.4%) experienced END. END was more prevalent in the patients with high IPF [13 (11.7%) vs 59 (3.8%), p&lt;0.0001]. Multivariate logistic regression analysis showed high IPF was an independent predictor of the prevalence of END (adjust odds ratio = 1.32; 95% confidence interval = 1.03–1.70). <h3>Conclusions:</h3> A high IPF levels was associated with the prevalence of END in acute ischemic stroke patients. Future investigation might be needed to evaluate the effective treatment of the high IPF in acute phase of ischemic stroke. <b>Disclosure:</b> Bang-Hoon Cho has nothing to disclose. The institution of Sung-Wook Yu has received research support from Yuhan.

Myeloproliferative Neoplasms and Aspirin: Does Increased Platelet Turnover Matter?

Platelet aggregation tests and the analysis of thromboxane A2 metabolites [serum thromboxane B2 (TXB2) and urine 11-dehydro TXB2] are used to evaluate the efficacy of aspirin. In myeloproliferative neoplasms (MPNs), the immature platelet fraction (IPF) rises due to enhanced platelet turnover, and this has been thought to reduce the efficacy of aspirin. This phenomenon is overcome by the recommendation of aspirin intake in divided doses. We aimed to evaluate aspirin efficacy in patients who were receiving aspirin treatment of 100 mg/day. Thirty-eight MPN patients and 30 control patients (non-MPN patients who received a single daily dose of aspirin at 100 mg for nonhematological conditions) were enrolled. IPF, serum TXB2, and urine 11-dehydro TXB2 levels were measured and aggregation tests with arachidonic acid and adenosine diphosphate were performed by light transmission aggregometry (LTA). Mean IPF and TXB2 levels were higher in the MPN group (p=0.008 and p=0.003, respectively). IPF levels were lower in patients on cytoreductive therapy in the MPN group (p=0.001), but these values were similar between patients on hydroxyurea and the non-MPN group (p=0.72). TXB2 levels did not differ according to hydroxyurea treatment status but were higher in the MPN group compared to non-MPN patients (23.63 ng/mL and 19.78 ng/mL, respectively; p=0.04). TXB2 values were higher in patients with essential thrombocythemia and a history of thrombotic events (p=0.031). No difference was observed in LTA between the MPN and non-MPN patient groups (p=0.513). Higher levels of IPF and TXB2 in the MPN patient group indicated platelets that could not be inhibited by aspirin. It was observed that patients under cytoreductive therapy had lower IPF values, but the expected decrease in TXB2 levels was not observed. These findings suggest that a lack of response to aspirin may be due to additional intrinsic factors rather than increased platelet turnover.

Role of Platelet Indices and Thrombopoietin (TPO) Serum Levels in the Differential Diagnosis of Thrombocytopenia

Background: The differential diagnosis of an isolated thrombocytopenia may be challenging, especially when it comes to differentiate immune thrombocytopenia (ITP) and an isolated thrombocytopenia in the context of bone marrow (BM) failure, in particular myelodysplastic syndromes (MDS); in such cases a BM examination is usually performed. It is known that thrombopoietin (TPO) serum levels are low in patients with ITP, while they are increased in case of amegakaryocytic thrombocytopenia. Furthermore, some platelet indices such as immature platelet fraction (IPF) may help to discriminate between hyporigenerative and consumption thrombocytopenia. Aim: The aim of this study was to compare TPO serum levels and platelet indices in patients with thrombocytopenia of different etiologies. Based on pathogenesis, we chose 3 groups of patients: ITP, amegakaryocytic thrombocytopenia (aplastic anemia (AA) or post-chemotherapy (CHT)) and thrombocytopenia in MDS and acute myeloid leukemia (AML). Although the diagnosis of amegakaryocytic thrombocytopenia and AML is straightforward with BM examination, we included patients with these diseases as a proof of concept and training set for our findings. Methods: This was a monocentric, retrospective, explorative study. Blood samples of patients with a platelet count < 100x109/L were collected. IPF, mean platelet volume (MPV), platelet distribution width (PDW), plateletcrit (PCT), platelet large cell ratio (P-LCR) were obtained using Sysmex XN-1000 hemocytometer (Sysmex Corporation). TPO serum levels were measured with a quantitative sandwich ELISA (R&D Systems). Microsoft Excel software was used for descriptive statistical analysis. Anova and Student's t-test were used for comparisons between groups. A p-value <0.05 was considered statistically significant. Results: We enrolled 84 patients: 50 ITP, 22 AML/MDS (13 AML, 9 MDS), 12 AA/post-CHT (4 AA, 8 post-CHT). Results are reported in Table 1. Neither mean platelet count (p=0.20) nor PCT (p=0.44) were significantly different between the three groups. Mean TPO serum levels were higher in patients with AA/post-CHT compared to ITP and AML/MDS groups (p<0.001). All patients in AA/post-CHT group had a TPO serum level >500 pg/mL, this value was never reached in patients with ITP and AML/MDS. TPO serum levels were higher in AML/MDS patients compared to ITP patients (p<0.001). While TPO serum levels were available for all patients, platelet indices were not, due to technical issues. IPF was available in 46/50 ITP patients, 20/22 AML/MDS and 8/12 AA/post-CHT, and it was higher in ITP patients if compared to AA/post-cht (p=0.021) and AML/MDS (p=0.0045). MPV, PDW and P-LCR were available in 27/50 ITP patients, 12/22 AML/MDS and 9/12 AA/post-CHT: they were higher in ITP patients than in the other groups (AML/MDS p=0.0185, AA/post-CHT p=0.017). In our cohort, patients with TPO ≥250 pg/mL and IPF <12% had a higher probability to belong to AML/MDS group (TPO: OR 0.08, 95% CI 0.02-0.32; IPF: OR 0.19, 95% CI 0.06-0.59). These findings were confirmed by multivariate analysis (IPF: p-value = 0.0185, CI 0.8647-0.9868; TPO: p-value = 0.004, CI 1.002-1.011). The other platelet indices were not included in this analysis due to the paucity of data. No correlation was found between platelet count, TPO and IPF in ITP patients. Of note, no differences were observed in terms of platelet count, TPO serum levels ad IPF between patients with AML and MDS. Conclusions: Our findings confirm that, in patients with the same platelet count, those with consumptive thrombocytopenia have higher IPF and lower TPO levels, while patients with amegakaryocytic thrombocytopenia have higher TPO levels and lower IPF. While TPO levels alone can distinguish amegakaryocytic thrombocytopenia from other etiologies, these preliminary data suggest that by combining IPF and TPO, patients with consumptive thrombocytopenia can be distinguished from MDS patients. This could be useful to spare BM examination in selected cases, or as an additional tool when the diagnosis remains uncertain also with BM examination. These data need to be confirmed in larger cohorts. The role of the other platelet indices, and the technical issues in their determination, needs further studies. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Transthyretin, Immature Platelet Fraction, and Mean Platelet Volume in Normotensive and Preeclampsia Pregnancy

BACKGROUND: Transthyretin protein experiences misfolding and aggregation in preeclampsia due to placental ischemia and inflammation. Placental endothelial damage occurring in preeclampsia stimulates the production of larger young platelets in the bone marrow and can be reflected by an increase in the immature platelet fraction (IPF) and mean platelet volume (MPV). Since the change in these markers in preeclampsia remains controversial, this study was conducted to analyze the differences in levels of transthyretin, IPF, and MPV as easily accessible markers in normotensive and preeclampsia pregnancies.METHODS: Total subjects included in this study were 32 normotensive and 26 preeclampsia pregnant woman. The measurement of serum transthyretin level was using enzyme-linked immunosorbent assay (ELISA) method. Meanwhile, IPF and MPV levels were measured by using a hematology analyzer with flowcytometry method. Data was statistically analyzed using unpaired T-test and Mann-Whitney, with significancy of p&lt;0.05.RESULTS: Median value of transthyretin in normotensive and preeclampsia pregnancy were 11 (6-30) mg/dL and 9 (5-18) mg/dL. The mean value of IPF in normotensive and preeclampsia pregnancy were 4.56±2.19% and 6.33±2.99%. Mean value of MPV in normotensive and preeclampsia pregnancy were 10.41±0.76 fL and 11.32±1.2 fL. There were significant differences in levels of transthyretin, IPF, and MPV between normotensive and preeclampsia pregnancies (p=0.008, p=0.017, and p=0.002, respectively).CONCLUSION: There are significant differences in transthyretin levels, IPF, and MPV values in normotensive and preeclampsia pregnancies. Therefore, serum transthyretin, IPF, and MPV can be developed as affordable parameters for the diagnosis of preeclampsia.KEYWORDS: preeclampsia, transthyretin, IPF, MPV

Impact of high platelet turnover on the platelet transcriptome: Results from platelet RNA-sequencing in patients with sepsis.

Sepsis is associated with high platelet turnover and elevated levels of immature platelets. Changes in the platelet transcriptome and the specific impact of immature platelets on the platelet transcriptome remain unclear. Thus, this study sought to address whether and how elevated levels of immature platelets affect the platelet transcriptome in patients with sepsis. Blood samples were obtained from patients with sepsis requiring vasopressor therapy (n = 8) and from a control group of patients with stable coronary artery disease and otherwise similar demographic characteristics (n = 8). Immature platelet fraction (IPF) was determined on a Sysmex XE 2100 analyser and platelet function was tested by impedance aggregometry. RNA from leukocyte-depleted platelets was used for transcriptome analysis by Next Generation Sequencing integrating the use of unique molecular identifiers. IPF (median [interquartile range]) was significantly elevated in sepsis patients (6.4 [5.3-8.7] % vs. 3.6 [2.6-4.6] %, p = 0.005). Platelet function testing revealed no differences in adenosine diphosphate- or thrombin receptor activating peptide-induced platelet aggregation between control and sepsis patients. Putative circular RNA transcripts were decreased in platelets from septic patients. Leukocyte contamination defined by CD45 abundance levels in RNA-sequencing was absent in both groups. Principal component analysis of transcripts showed only partial overlap of clustering with IPF levels. RNA sequencing showed up-regulation of 524 and down-regulation of 118 genes in platelets from sepsis patients compared to controls. Upregulated genes were mostly related to catabolic processes and protein translation. Comparison to published platelet transcriptomes showed a large overlap of changes observed in sepsis and COVID-19 but not with reticulated platelets from healthy donors. Patients with sepsis appear to have a less degraded platelet transcriptome as indicated by increased levels of immature platelets and decreased levels of putative circular RNA transcripts. The present data suggests that increased protein translation is a characteristic mechanism of systemic inflammation.

OR43. Immature Platelet Fraction Levels and mayor adverse cardiac events in Acute Coronary Syndrome accompanied by Pneumonia Corona Virus Disease 19

Abstract Introduction Acute Coronary Syndrome is a major cardiovascular problem and currently is one of the complications of COVID-19. Immature platelet fraction (IPF) is newly released platelets and have strong thrombotic potential. Recent research has shown that IPF levels are higher in ACS and COVID-19 patients. In this study, we tried to see the IPF levels and ACS outcomes occurred in COVID-19 patients during the hospitalization period. Metods and Results This study is an analytical observational study with a cohort design that was conducted in August 2020 - December 2020 with 28 sample and follow up during hospitalization. IPF levels In the group following MACE, the IPF median was 5 and in the group that did not following MACE the IPF median was 2.40 . Based on statistical calculations, there were significant differences between the two groups (p = 0.004). Meanwhile, the group that following MACE and survivors got a median value 4.90 and grup following MACE and non-survivors a median value of 5.00. Based on statistical calculations, there was no significant difference between the two groups (p = 0.670). Conclussion The IPF level in ACS patients accompanied by covid who occurance MACE was significantly higher than those without MACE. And it was found that the IPF level was higher in non-surviving patients than in non-surviving patients, but it was not statistically significant.

Immature platelets in patients with Covid-19: association with disease severity.

Coronavirus disease 2019 (Covid-19) is associated with a high incidence of venous and arterial thromboembolic events. Currently, there are no clinical or laboratory markers that predict thrombotic risk. Circulating immature platelets are hyper-reactive platelets, which are associated with arterial thrombotic events. The aim of this study was to assess whether the proportion of circulating immature platelets is associated with disease severity in Covid-19 patients. Patients admitted with Covid-19 disease were prospectively assessed. Immature platelet count (IPC) and immature platelet fraction (IPF) were measured at admission and at additional time points during the hospital course using the Sysmex XN-3000 auto-analyzer. A total of 136 consecutive patients with Covid-19 were recruited [mean age 60 ± 19 years, 49% woman, 56 (41%) had mild-moderate disease and 80 (59%) had severe disease at presentation]. The median IPF% was higher in patients with severe compared to mild-moderate disease [5.8 (3.9–8.7) vs. 4.2 (2.73–6.45), respectively, p = 0.01]. The maximal IPC value was also higher in patients with severe disease [15 (10.03–21.56), vs 10.9 (IQR 6.79–15.62), respectively, p = 0.001]. Increased IPC was associated with increased length of hospital stay. Patients with severe Covid-19 have higher levels of IPF than patients with mild-moderate disease. IPF may serve as a prognostic marker for disease severity in Covid-19 patients.

Immature Platelet Fraction (IPF) Levels in Acute Coronary Syndrome (ACS) Patients

Background: Acute Coronary Syndrome (ACS) is a major cardiovascular problem because it causes high hospital admissions and mortality rates. Acute Coronary Syndrome is divided into 3 (three), namely: unstable angina pectoris (UAP), myocardial infarction without ST segment elevation (NSTEMI), and myocardial infarction with ST segment elevation (STEMI). In addition to changes in biomarkers of heart injury, the platelet index (IPF = immature platelet fraction) will also change the level difference between STEMI with NSTEMI/UAP. Objective: To determine the differences in IPF levels of ACS patients with STEMI and NSTEMI/UAP Method: Observational analytic with cross sectional approach. The subjects of this study were 80 patients who came to the emergency installation of integrated heart center Emergency Room Haji Adam Malik Hospital Medan from May 2019 to September 2019 and was diagnosed with ACS (STEMI or NSTEMI/UAP). The sample in the study was the patient's venous blood and put it in an EDTA tube, then immediately checked the IPF value/level using the automatic hematology analyzer. Patients with heart failure or patients with thrombocytopenia were not included in this study. Results: In this study, the demographic characteristics of the ACS patients based on gender were male 77.5% STEMI and 87.5% NSTEMI/UAP while women 22.5% STEMI and 12.5% ​​NSTEMI/UAP. The results of the STEMI patient's IPF levels Compared with NSTEMI/UAP, the median is 6.2 (3.5-16.8) VS 2.9 (0.7-12) with a p-value of 0.0001. Conclusion: The characteristics of ACS patients based on the results of sex were that there were more men with NSTEMI/UAP than those with STEMI. There was a significant difference in the IPF levels of STEMI with NSTEMI/UAP. Keywords: Immature Platelet Fraction (IPF), Acute Coronary Syndrome (ACS), ST-Segment Elevation Myocardial Infarction (STEMI), Non ST-Segment Elevation Myocardial Infarction (NSTEMI), Unstable Angina Pectoris (UAP).

Immature platelet fraction over time and clinical outcomes in patients with acute myocardial infarction.

Immature platelets in the circulation can be measured as immature platelet fraction (IPF). Limited data exist regarding IPF during the course of an acute myocardial infarction (AMI), the association between IPF and extent of cardiac damage, and the long-term prognostic implications of IPF in patients with AMI. To examine the temporal course of IPF during the first month after AMI, the association between IPF and extent of cardiac damage, and the long-term prognostic effect of IPF in AMI patients. Patients with AMI treated with percutaneous coronary intervention (PCI) were examined. IPF was evaluated by a Sysmex XN-3000 autoanalyzer, at 4 time points: baseline; one day post-PCI; 3days post-PCI, and 30days post-PCI. The association between peak troponin-T levels and IPF was evaluated. One-year clinical outcomes (cardiac hospitalization, urgent revascularization, or death) were assessed. One hundred patients were included, mean age was 59.5±11.3years, 82 were men, 27 had diabetes, and 54 were hospitalized with ST-segment elevation myocardial infarction (STEMI) and 46 with non-ST segment elevation myocardial infarction (NSTEMI). The levels of IPF modestly decreased a day after PCI but did not change in subsequent measurements. Peak troponin-T level was significantly associated with the levels of IPF at all 4 time points. IPF levels three days post-PCI were associated with the composite clinical outcome at 1year. The levels of IPF following AMI remain relatively stable over a one-month period. Higher levels of IPF during the acute phase of AMI appear to be associated with worse cardiac outcomes at 1year.

Role of immature platelet fraction (IPF) in sepsis patients: A systematic review.

Sepsis is extremely common amongst critically ill patients and requires early diagnosis. Hence, identifying a biomarker that could acknowledge sepsis at its prior stage is of vital significance. Immature platelets are a percentage of circulating platelets that contain RNA and is a newer parameter that is measured using automated hematology analyzers in diagnosing sepsis. This review article discusses 10 articles that reveal the role of immature platelet fraction in predicting the onset of sepsis and its relationship with mortality in sepsis. Literature search was done using PubMed, Scopus and Google Scholar and words like platelet indices and immature platelet fraction were typed in the search bar. The aim of this review article is to present a precise form of data that talk about immature platelet fraction (IPF) and its association with the severity and mortality of sepsis. Five out of 10 articles suggest that immature platelet fraction can predict the onset of sepsis and eight out of 10 articles suggest that increased IPF values are associated with high mortality.

Impact of uric acid on immature platelet fraction in patients undergoing percutaneous coronary intervention

IntroductionReticulated platelets have been involved in the pathophysiology of coronary artery disease (CAD). Immature platelet fraction (IPF) allows their measurement in daily clinical practice, although the factors conditioning their elevation are still largely unexplored. Serum uric acid (SUA) is the end product of purine metabolism, displaying a pro-oxidant and pro-inflammatory action and increasing the cardiovascular risk. The aim of our study was to investigate the impact of SUA on IPF levels in patients undergoing percutaneous coronary intervention (PCI), and their relationship with CAD. MethodsWe enrolled a cohort of consecutive patients undergoing coronary angiography in a single center. Hyperuricemia was defined by SUA ≥ 6.5 mg/dl. Significant CAD was defined as at least 1 vessel stenosis >50%, while severe CAD was defined as left main and/or three-vessel disease. IPF was measured at admission by routine blood cells count (A Sysmex XE-2100). ResultsWe included in our study 2217 patients, of whom 544 had high levels of SUA, while 1673 had normal levels. Hyperuricemics were older, with higher percentage of renal failure, hypertension, dilated cardiomyopathy or valvular disease as indication to angiography, higher levels of creatinine and C-reactive protein (p < 0.001, respectively) when compared to normouricemics. Immature platelet fraction (IPF) was significant higher in hyperuricemic patients (3.96% vs 3.59%, p = 0.004). A progressive direct increase in the IPF values was observed in relation to SUA levels (r = 0.101, p < 0.001), although at multivariate analysis, hyperuricemia did not result as an independent predictor of IPC in 3rd tertile (adjusted OR [95%CI] = 1.21 [0.85–1.71] P = 0.288). When stratifying hyperuricemics and normouricemics according to IPF tertiles (<2.3%; 2.3–3.9%; ≥ 4%), reticulated platelets were not associated to the prevalence of CAD (SUA ≥6.5:80.9 vs 79.3% vs 78.6%, p = 0.60; SUA < 6.5: 79.3% vs 81.3% vs 78.9%, p = 0.878) or severe CAD (SUA ≥6.5: 34.9% vs 38.9% vs 35.2%, p = 0.99; SUA < 6.5: 30.4% vs 33.5% vs 34%, p = 0.192), and the results were confirmed at multivariate analysis for CAD (SUA ≥6.5: adjusted OR [95%CI] = 1.11 [0.81–1.51] P = 0.524, SUA < 6.5: adjusted OR [95%CI] = 0.89 [0.75–1.05] P = 0.170) or severe CAD (SUA ≥6.5: adjusted OR [95%CI] = 1.03 [0.81–1.31] P = 0.795; SUA < 6.5: adjusted OR [95%CI] = 1.10 [0.96–1.26] P = 0.192). ConclusionsIn the present study we found a direct relationship between SUA levels and IPF values; however, hyperuricemia did not result as an independent predictor of higher IPF tertile values. Neither in hyperuricemics nor in normouricemics higher IPF were independently associated to the prevalence of CAD or severe CAD.

Association between Platelet-Associated Immunoglobulin G Levels and Response to Corticosteroid Therapy in Patients with Newly Diagnosed Immune Thrombocytopenia

Objective: Platelet-associated immunoglobulin G (PA-IgG) refers to IgG attached to the surface of platelets, while the immature platelet fraction (IPF) reflects the state of platelet production in bone marrow. Since PA-IgG and IPF are increased in patients with immune thrombocytopenia (ITP), reflecting amounts of platelet antibodies and compensatory platelet production, respectively, we hypothesized that these laboratory findings may provide useful markers for predicting treatment response in patients with ITP. We therefore retrospectively investigated associations between levels of these markers at diagnosis and response to first-line therapy in patients with ITP. Methods: Forty-three patients diagnosed with ITP at Oita Kouseiren Tsurumi Hospital between May 2010 and November 2018 were included. Patients were divided into 2 groups based on response to corticosteroid as first-line therapy. Laboratory findings were compared between responders and nonresponders. Results: Median PA-IgG was 285 ng/10⁷ cells (range, 45.5–18,200 ng/10⁷ cells), and median IPF was 15.5% (range, 5.4–62.1%). Median levels were higher than the respective upper limits of normal range (PA-IgG, 0–46 ng/10⁷ cells; IPF, 1.1–9.5%). First-line therapy was performed using standard-dose prednisolone (0.5–1.0 mg/kg/day) in 32 patients and high-dose dexamethasone (40 mg/day, 4 days) or methylprednisolone (125–1,000 mg/day, 3–4 days) in 11 patients. Twenty-four patients (55.8%) responded to first-line therapy. In univariate analysis, type of corticosteroid (p = 0.17) tended to differ between groups but did not differ significantly, and no difference in IPF level was apparent between responders (15.35%; range, 5.4–41.5%) and nonresponders (16.7%; range, 6.3–62.1%; p = 0.15). PA-IgG was significantly higher among nonresponders (430 ng/10⁷ cells; range, 101–18,200 ng/10⁷ cells) than among responders (254.5 ng/10⁷ cells; range, 45.5–470 ng/10⁷ cells; p = 0.004). Multivariate analysis revealed PA-IgG was independently associated with response to first-line therapy (odds ratio, 1.000; 95% confidence interval, 1.000–1.010; p = 0.029). Conclusion: Our data suggested that PA-IgG at diagnosis could offer a useful predictor of response to first-line corticosteroid therapy for ITP.

Platelet indices as a predictive marker in neonatal sepsis and respiratory distress in preterm prelabor rupture of membranes.

Preterm Prelabor rupture of membranes (PPROM) accompanies 2-3% of all pregnancies and 1/3rd of all preterm deliveries leading to intraamniotic infection, postpartum infections, sepsis along with perinatal morbidity and mortality worldwide. Early diagnosis and treatment can prevent the complications of PPROM and improve mother and child health. The platelet indices (platelet count, Mean platelet volume, Plateletcrit and Immature platelet fraction) could be a useful predictive parameters in PPROM, as platelets are acute phase reactants and there parameters may vary with inflammation and increased platelet consumption/production. In the present study, Mean Platelet volume (MPV) levels showed significant increase in cases as compared to controls (10.47 ± 1.92fl Vs 8.84 ± 1.30fl; P < 0.004). Plateletcrit (PCT) levels were also significantly increased in cases with respect to controls (0.22 ± 0.10% Vs 0.18 ± 0.05%; P = 0.004). Immature platelet fraction (IPF) is significantly increased in cases than in control subjects (8.73 ± 6.67% Vs 4.43 ± 1.75%; P < 0.001). Also, Mean Platelet volume (MPV) levels were found to be significantly higher in subjects whose neonate had developed sepsis(11.39 ± 1.69fl Vs 8.91 ± 1.31fl; P < 0.001) and respiratory distress (10.62 ± 2.09fl Vs 9.26 ± 1.56fl; P = 0.003). Similarly, PCT was significantly higher in groups with positive neonatal sepsis (0.32 ± 0.74% Vs 0.19 ± 0.65%; P = 0.010) and with respiratory distress (0.24 ± 0.78% Vs 0.18 ± 0.59%; P < 0.001). Levels of IPF were also increased in positive neonatal sepsis group (10.11 ± 6.27% Vs 5.06 ± 4.07%; P < 0.001) and respiratory distress group (9.11 ± 6.38% Vs 5.54 ± 4.43%; P = 0.009). The findings suggest that maternal platelet parameters (MPV, PCT and IPF) can be utilized as evidence of early predictors of development of neonatal sepsis and respiratory distress and may be considered as a predictive markers for adverse neonatal outcome.