Diagnostic Utility of Immature Platelet Fraction (IPF) in Differentiating Thrombocytopenia Due to Increased Thrombopoietic Activity

Introduction: Thrombocytopenia, a frequent finding in haematology, often necessitates comprehensive investigations to determine its underlying cause. The Immature Platelet Fraction (IPF) has emerged as a potential diagnostic marker for thrombocytopenia associated with increased thrombopoietic activity.

Aim: This study aimed to evaluate the diagnostic utility of IPF in differentiating thrombocytopenia due to increased thrombopoietic activity and to assess potential variations in IPF by age and sex.

Methods: This prospective observational study included 100 patients with thrombocytopenia who were classified into two groups: those with and without increased thrombopoietic activity. Peripheral blood samples were analyzed using a Full Blood Count (FBC) analyzer capable of measuring IPF. Statistical analysis was conducted using SPSS version 20, with a p-value < 0.05 considered statistically significant. Receiver Operating Characteristic (ROC) curve analysis was employed to determine the diagnostic accuracy of IPF in identifying thrombocytopenia associated with increased thrombopoietic activity.

Results: A total of 62 patients with thrombocytopenia without increased thrombopoietic activity had a mean IPF of 5.59% (95% CI: 3.4–7.8). In contrast, the mean IPF was significantly higher at 14.38% (95% CI: 9.4–19.4) among 38 patients with thrombocytopenia and increased thrombopoietic activity (p = 0.00). An IPF cut-off value of 8% demonstrated a sensitivity of 100%, specificity of 87%, a positive predictive value (PPV) of 82%, and a negative predictive value (NPV) of 100%. No statistically significant differences in IPF were observed across age or sex groups.

Discussion: The findings indicate that IPF is a reliable screening tool for differentiating between thrombocytopenia with high and low thrombopoietic activity. The high sensitivity and specificity of the IPF cut-off value of 8% underscore its diagnostic utility. These results align with previous studies highlighting the clinical relevance of IPF in assessing platelet production dynamics. The absence of significant differences based on age or sex suggests that IPF can be broadly applied across diverse patient populations.

Conclusion: IPF, as determined by automated analyzers, is an effective diagnostic marker for evaluating thrombocytopenia. An IPF value greater than 8% provides excellent sensitivity and good specificity for identifying thrombocytopenia associated with increased thrombopoietic activity, making it a valuable tool for guiding clinical decision-making. Future research may focus on integrating IPF into routine diagnostic workflows and exploring its application in broader haematological conditions.