Immature platelets: immature platelet fraction (IPF) and immature platelet count (IPF#)
What are IPF and IPF# parameters?
IPF and IPF# parameters quantify the presence of immature platelets in the blood sample, and they are platelet analogues of reticulocytes (RET% and RET#) in red cell populations. These parameters can be easily determined from a patient’s peripheral blood sample together with complete blood count during the routine laboratory analysis of an EDTA sample. Compared to their mature platelet counterparts, immature platelets are young and more reactive.
- IPF is the percentage of immature platelets within the total platelet count.
- IPF# is the absolute count of immature platelets.
How are they measured?
Immature or reticulated platelets are newly released from the bone marrow, reflecting its activity and their high level of RNA is measured using a specific fluorescence method.
IPF and IPF# are diagnostic parameters obtained from Sysmex’s haematology analysers equipped with the optional PLT-F channel. In the PLT-F channel, all platelets are specifically stained with a fluorescent dye and counted. The population in the area of high forward scatter and high fluorescence intensity is separated as immature platelets.
Reference ranges (adults)
IPF: 1.2-8.9% [1]
IPF#: 3.1-18.7 x 109/L [1]
Statement
Our study strongly suggests that IPF is useful in the differential diagnosis between MYH9 disorders and other types of thrombocytopenia. (Kouno H et al. 2023)
Benefits
Several clinical benefits were documented in the literature for IPF and IPF# parameters:
- In several studies the immature platelet fraction has been demonstrated to assist in the differential diagnosis of thrombocytopenia [2-6].
- The immature platelet count was found to reflect real-time effective bone marrow response to ITP treatment [7].
- The study by Greene LA et al. found that increased immature platelet count is associated with a lower bleeding risk in severely thrombocytopenic patients [8].
- The immature platelet count and fraction, as a measure of residual platelet reactivity, was discovered to be a predictor of the efficacy of antiplatelet therapy [9-12].
- The immature platelet count was found to be used to assess the risk of future cardiovascular adverse events [13–15].
Downloads
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White Paper Differential diagnosis of thrombocytopeniaPDF (354 KB)
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White Paper Identifying poor antiplatelet drug response and adverse cardiovascular events risks early onPDF (318 KB)
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White Paper The value of the immature platelet count for managing immune thrombocytopenia (ITP) treatment and assessing the risk of bleedingPDF (569 KB)
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Information card Identifying poor antiplatelet drug response and its risks early onPDF (342 KB)
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Information card Immediate support for determining the cause of thrombocytopeniaPDF (330 KB)
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Information card Managing immune thrombocytopenia (ITP) treatment efficientlyPDF (335 KB)
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Information card The expert channel for platelet measurementPDF (379 KB)
References
[1] L van Pelt J et al. (2022): Reference intervals for Sysmex XN hematological parameters as assessed in the Dutch Lifelines cohort. Clin Chem Lab Med 60(6): 907–20.
[2] Miyazaki K et al. (2015): Immature platelet fraction measurement is influenced by platelet size and is a useful parameter for discrimination of macrothrombocytopenia. Hematology. 20(10): 587–92.
[3] Cannavo I et al. (2010): Assessment of an immature platelet fraction (IPF%) in the diagnosis of thrombocytopenia. Ann Biol Clin (Paris). 68(4): 415–20.
[4] Strauss G et al. (2011): Immature platelet count: a simple parameter for distinguishing thrombocytopenia in pediatric acute lymphocytic leukemia from immune thrombocytopenia. Pediatr Blood Cancer. 57(4): 641–7.
[5] Adly AA et al. (2015): Evaluation of the immature platelet fraction in the diagnosis and prognosis of childhood immune thrombocytopenia. Platelets. 26(7): 645–50.
[6] Sakuragi M et al. (2015): Clinical significance of IPF% or RP% measurement in distinguishing primary immune thrombocytopenia from aplastic thrombocytopenic disorders. Int J Hematol. 101(4): 369–75.
[7] Barsam SJ et al. (2011): Platelet production and platelet destruction: assessing mechanisms of treatment effect in immune thrombocytopenia. Blood. 117(21): 5723–32.
[8] Greene LA et al. (2014): Beyond the platelet count: immature platelet fraction and thromboelastometry correlate with bleeding in patients with immune thrombocytopenia. Br J Haematol. 166(4): 592–600.
[9] Wurtz M et al. (2014): 24-hour antiplatelet effect of aspirin in patients with previous definite stent thrombosis. Int J Cardiol. 175(2): 274–9.
[10] Guthikonda S et al. (2007): Reticulated platelets and uninhibited COX-1 and COX-2 decrease the antiplatelet effects of aspirin. J Thromb Haemost. 5(3): 490–6.
[11] Ibrahim H et al. (2012): Immature platelet fraction (IPF) determined with an automated method predicts clopidogrel hyporesponsiveness. J Thromb Thrombolysis. 33(2): 137–42.
[12] Perl L et al. (2014): Response to prasugrel and levels of circulating reticulated platelets in patients with ST-segment elevation myocardial infarction. J Am Coll Cardiol. 63(6): 513–7.
[13] Cesari F et al. (2013): Reticulated platelets predict cardiovascular death in acute coronary syndrome patients. Insights from the AMIFlorence 2 Study. Thromb Haemost. 109(5): 846–53.
[14] Lopez-Jimenez RA et al. (2013): Immature platelet fraction: a new prognostic marker in acute coronary syndrome. Rev Esp Cardiol (Engl Ed). 66(2): 147–8.
[15] Ibrahim H et al. (2014): Association of immature platelets with adverse cardiovascular outcomes. J Am Coll Cardiol. 64(20): 2122–9.
