Utility of immature platelet fraction to predict platelet recovery in dengue patients having thrombocytopenia

Megha Agarwal, Pradeep Kumar Bansal, M. L. Yadav


Background: Dengue is one of the most common viral and probably also the most common important arbovirus infections in the world. Thrombocytopenia in patients with dengue may cause a steep fall in platelet count, warrant for platelet transfusion. However, unnecessary transfusions are best avoided due to heightened risk from alloimmunization, immunosuppression, transmission of infectious diseases and graft-vs.-host disease. This brings us to the issue of how we can reliably predict the rise in the platelet count. IPF count holds great promise of being this predictor. The aim of this study was to establish the relationship between IPF and increase in platelet count in patients with dengue who suffer from thrombocytopenia.

Methods: This is a hospital based observational descriptive study done in November 2017 to August 2019 on all the dengue patients who were positive for NS1 antigen or IgM antibody or both and treated at Mahatma Gandhi Medical College and Hospital, Jaipur. The values of platelet and IPF were retrieved for day 1st, 3rd, 5th and 7th day of admission. Association between values of IPF and significant clinical change in platelet values during the subsequent 48 hrs is done. A sensitivity analysis was carried out to ascertain the cut-off of IPF on the corresponding days which yielded increase in platelet values of over 20,000 in the subsequent 48 hrs.  

Results: There is statistically significant (P<0.01) improvement in platelet values within 48 hrs when the IPF is more than 6.1%.

Conclusions: IPF is an additional parameter to predict platelet recovery, so that prophylactic platelet transfusion can be deferred and also the hazards associated with it.


Dengue, Platelets, Immature platelet fraction, Platelet transfusion

Full Text:



Simmons CP, Farrar JJ, Nguyen vV, Wills B. Current Concepts. N Engl J Med 2012; 366:1423-32.

Srichaikul T, Nimmannitya S Haematology in dengue and dengue haemorrhagic fever.Baillieres Best Pract Res Clin Haematol. 2000;13(2):261-76.

Briggs C, Hart D, Kunka S, Oguni S, Machin S. Immature platelet fraction measurement: a future guide to platelet transfusion requirement after haematopoietic stem cell transplantation. Transfus Med 2006;16:101–9.

Briggs C. Quality counts: new parameters in blood cell counting. Int J Lab Hematol 2010;31:277–97.

Lemes A, Molero J, Lopez P, Martin P,Luzardo H, Martin R, Garcia GD, De la Iglesia S, Jimenez S. Immature platelet fraction (IPF) utility in follow up patients receiving chemotherapy. Haematologica 2007;92:425–8.

Saigo K, Sakota Y, Masuda Y, Matsunaga K, Takenokuchi M, Nishimura K et al. Automatic detection of immature platelets for decision making regarding platelet transfusion indications. Transfus Apher Sci, 2008;38(2):127-32.

Dadu, T, Sehgal K, Joshi M, Khodaiji, S. Evaluation of the immature platelet fraction as an indicator of platelet recovery in dengue patients. Internat J Lab Hematol. 2013.

Carol B, Ian L, Punamar K. Performance evaluation of the Sysmex haematology XN modular system. J Clin Pathol, 2012;0:1-7.

Febe R Suman, Lawrence D’Cruze. Dengue: platelet and immature platelet dynamics a study done at a tertiary care centre from South India. Int J Rec Trend Sci Tech. 2014;12(1):620-3.

Francisca RF, Guerreiro A, Romelia PG, Marin HP, Daniella M.L.IVOCB Dengue: Profile of haematological and biochemical dynamics. Rev. Bras Haematol, 2012;34:1-10.

Irfan A, Fayyaz AM, Aamir H, Shahida ARS. Dengue fever; cliniciopathologic correlations and their associations with poor outcome. Professional Med J. 2011;18:57-63.

Sara JB, Bethau P, Mare F, Lemke KP, Peter AS. Platelet production and platelet destruction assessing mechanisms of treatment effect in immune thrombocytopenia (ITP). Blood, 2010;11:321-98.

Hinzmann R. The clinical significance of themeasurement of immature platelets. Sysmex lab info. 2005.