Immature Platelet Fraction in Thrombocytopenic Patients

Bone marrow puncture (BMP), is usually performed to identify thrombopoiesis activity and is still the gold standard to determine the etiology of thrombocytopenia. This diagnostic test is invasive hence it may cause discomfort to the patient. One of noninvasive test to determine the etiology of thrombocytopenia is by measuring immature platelet fraction (IPF). IPF is highly correlated to the activity of thrombopoiesis and by understanding the value, clinicians are able to use it in determining whether or not invasive examination is needed and more importantly avoiding unnecessary platelet transfusion. This research was a cross-sectional descriptive observational study aimed to evaluate IPF value in thrombocytopenic inpatients in the Department of Internal Medicine, Haji Adam Malik Hospital Medan. 83 people were recruited, 48 were female (57.83%) and 35 were male (42.16%). IPF values ranged 0,5-59,6% using Sysmex XN-1000 (reference range 1-4,8%). There were 5 (6.02%) low IPF values, 29 (34.93%) normal IPF values and 49 (59.03%) high IPF values. Evaluation of IPF in thrombocytopenic patients is a promising tool to discriminate central from peripheral thrombocytopenia.

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An Increase in the Immature Platelet Fraction Predicts Reconstitution of the Platelet Count and May Reduce Prophylactic Platelet Transfusions after Stem Cell Transplantation.

Blood ◽

10.1182/blood.v104.11.3632.3632 ◽

2004 ◽

Vol 104 (11) ◽

pp. 3632-3632

Author(s):

Samuel J. Machin ◽

Dan Hart ◽

Stefan Kunka ◽

Carol Briggs ◽

Laurence Corash

Keyword(s):

Bone Marrow ◽

Stem Cell ◽

Platelet Count ◽

Platelet Transfusion ◽

Thrombocytopenic Purpura ◽

Platelet Recovery ◽

Transplant Patients ◽

Automated Method ◽

Immature Platelet Fraction ◽

Platelet Transfusions

Abstract A new automated method to reliably quantitate reticulated platelets, expressed as the immature platelet fraction (IPF), has been developed on an automated cell counter (XE-2100, Sysmex). The IPF is identified by flow cytometery using a polymethine dye, staining platelet RNA, in the reticulocyte channel; the results are available at the same time as the CBC. The IPF normal range is 1.1–6.1%, mean 3.4%, 2 SD 2.3%. Reproducibility and stability results over 48 hours were acceptable. The IPF is raised when there is increased peripheral consumption/destruction. In untreated idopathic thrombocytopenic purpura, n = 12, mean 22.3%, range 9.2–33.1% and active thrombotic thrombocytopenic purpura, n = 5, mean 17.2%, range 11.2–30.9%. Patients who may require prophylactic platelet transfusion, usually at threshold counts less than 10 x 109/L, to support periods of marrow aplasia were monitored daily for platelet count and IPF%. The recovery phase of thrombocytopenia in most chemotherapy (n=13) and stem cell/bone marrow transplant patients (n=15) was preceded by a rise in IPF% several days prior to platelet recovery, mean IPF 13.7%, range 7–27.3%. In particular, patients undergoing autologous transplantation (n=8) using peripherally collected stem cells have a very characteristic IPF% motif, with a rise 1 day prior to engraftment for all patients except one where it was 2 days prior. For bone marrow derived transplant patients the increase in IPF was more variable, the rise preceded the rise in platelet count by 2–7days. These patients suffer more septic episodes where there is a rise in the IPF with no immediate increase in the platelet count, and require more regular platelet transfusions. Following a platelet transfusion there is a 24-hour transitory fall in the IPF response, which may impede platelet recovery. A parameter that could predict the timing of platelet recovery could be used clinically to reduce the use of prophylactic platelet transfusion in these patients, thus minimising donor exposure, infection risk and allowing substantial financial savings. The IPF is a useful parameter in the evaluation of the thrombocytopenic patient and has the potential to allow more optimal transfusion of platelet concentrates.

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An observational study to see the correlation between trends of platelet counts and immature platelet fraction in dengue infection

Tropical Doctor ◽

10.1177/00494755211017012 ◽

2021 ◽

pp. 004947552110170

Author(s):

Darshit Shah ◽

Mridusmita Khataniar ◽

Aanchal Sawhney ◽

Manishi Nautiyal ◽

Rishikesh Desai ◽

...

Keyword(s):

Bone Marrow ◽

Platelet Count ◽

Blood Transfusion ◽

Observational Study ◽

Low Income ◽

Strong Correlation ◽

Platelet Transfusion ◽

Dengue Infection ◽

Viral Disease ◽

Immature Platelet Fraction

Dengue, a common tropical viral disease, often has complications of thrombocytopenia causing bleeding and warranting blood transfusion. This is costly in low-income settings. We conducted an observational study using a relatively new parameter called immature platelet fraction which indicates regeneration of platelets by the bone marrow. Our study on 124 dengue patients showed a strong correlation between platelet count and immature platelet fraction and we observed that 96.1% and 97.4% patients showed rise in platelet count at 24 and 48 h, respectively. In the absence of bleeding, platelet transfusion was prevented in 64% of patients with an IPF level of 10% or more.

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ANALISIS EOSINOFIL DARAH TERKAIT RADANG SEL GINJAL AKUT/ NEFRITIS INTERSTISIAL AKUT (NIA)

INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY ◽

10.24293/ijcpml.v16i2.964 ◽

2018 ◽

Vol 16 (2) ◽

pp. 65

Author(s):

Yedid Lebang ◽

Sulina Yanti Wibawa ◽

Mansyur Arif

Keyword(s):

Internal Medicine ◽

Clinical Sign ◽

Gold Standard ◽

Statistical Difference ◽

Acute Interstitial Nephritis ◽

Cross Sectional Study ◽

Interstitial Tissue ◽

Sectional Study ◽

Cross Sectional ◽

Medicine Department

Acute Interstitial Nephritis (AIN) is the main cause of acute renal failure because of hypersensitivity to many antibiotics and otherdrugs that potent to induce allergic response in renal interstitial tissue. Gold standard for AIN diagnosis upheld from clinical sign,laboratory, USG, Gallium renal tests and renal biopsy. A cross sectional study was carried out among 120 (AIN) patients and none (AIN)from the Paediatrics and Internal Medicine Department Wahidin Sudirohusodo hospital from June until September 2008. Eosinophilcount was performed using haematology auto analyser. The data was analyzed by Mann-Whitney test using SPPS for windows. Thetotal 120 samples consisted of 60 samples of AIN and 60 samples Non AIN were included in this study. Mean eosinophil in AIN 4. 9 %and non AIN 3. 1%. There were statistical difference of eosinophil level between AIN and non AIN with p < 0. 00. Eosinophil level canbe used to differentiated between AIN and non AIN in conjunction to the clinical sign.

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Measurement of the Absolute Immature Platelet Number Reflects Marrow Production and Is Not Impacted by Platelet Transfusion

Blood ◽

10.1182/blood.v120.21.3425.3425 ◽

2012 ◽

Vol 120 (21) ◽

pp. 3425-3425

Author(s):

Taha Bat ◽

Susan F. Leitman ◽

Katherine R Calvo ◽

Donna Chauvet ◽

Cynthia E. Dunbar

Keyword(s):

Bone Marrow ◽

Platelet Transfusion ◽

Conflicts Of Interest ◽

Bone Marrow Failure ◽

High Dose Chemotherapy ◽

High Dose ◽

Immature Platelet Fraction ◽

Platelet Number ◽

The Impact

Abstract Abstract 3425 Background The ability to distinguish increased platelet destruction from platelet hypo-production is important in the care of patients with bone marrow failure syndromes and patients receiving high dose chemotherapy. The measurement of immature circulating platelets based on RNA content using an automated counter is now feasible. This study evaluated the impact of recent platelet transfusion on measurement of immature platelet parameters. Study Design and Methods The immature platelet fraction (IPF) and absolute immature platelet number (AIPN) were measured using the Sysmex XE-5000 analyzer prior to and following platelet transfusion in 9 transfusion-dependent patients with marrow failure secondary to aplastic anemia, myelodysplasia or transplantation conditioning. IPF and AIPN were also measured serially over 5 days of storage in 3 plateletpheresis components collected from normal donors. Results Platelet transfusion did not significantly change the mean AIPN in transfused patients. In contrast, IPF decreased significantly from 6.6 ±4.6% at day -1 to 2.3 ±1.4% at day 0 before returning to 4.3 ±2.3% at day +1. In the platelet component, AIPN and IPF% increased significantly over 5 days of storage, most likely due to an artifact of the staining and detection process for stored platelets, no longer detected in vivo once the platelets were transfused. Conclusion Platelet transfusion decreases the IPF due to the resultant increase in circulating platelet count. However, platelet transfusion does not change the circulating absolute immature platelet number (AIPN), validating this assay as a reflection of ongoing platelet production by the bone marrow in various clinical settings, regardless of proximity to platelet transfusion. Disclosures: No relevant conflicts of interest to declare.

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Learning Electrocardiogram Interpretation: Insights from Residents and a Proposed Solution in an Observational Study (Preprint)

10.2196/preprints.19645 ◽

2020 ◽

Author(s):

Mohammad Alakchar ◽

Abdisamad M. Ibrahim ◽

Mohsin Salih ◽

Mukul Bhattarai ◽

Nitin Tandan ◽

...

Keyword(s):

Internal Medicine ◽

Correlation Coefficient ◽

Online Survey ◽

Cross Sectional Study ◽

Cross Sectional ◽

Resident Attitudes ◽

Internal Medicine Residents ◽

Life Threatening ◽

Degree Of Participation ◽

Electrocardiogram Interpretation

BACKGROUND Interpretation of electrocardiograms (EKG) is an essential tool for every physician. Despite this, the diagnosis of life-threatening pathology on EKG remains suboptimal in trainees. The purpose of this study is to study resident attitudes and behaviours towards EKGs, and describe an innovative way to teach EKGs. OBJECTIVE Study attitudes and behaviours towards EKGs. Describe an innovative way to teach EKGs. METHODS Design: An observational cross-sectional study through an anonymous online survey of resident attitudes and comfort with EKG interpretation. This was followed by creation of a WhatsApp group for discussion and interpretation of EKGs with peers. At the end of the day, the official EKG interpretation was posted. Setting: Internal medicine residency at Southern Illinois University. Participants: Internal medicine residents Interventions: Creation of WhatsApp group to aid with EKG interpretation Measurements: A 17 item questionnaire, followed by detection of degree of participation in a WhatsApp group. RESULTS Forty-one out of 63 residents (65%) completed the survey. 85% of respondents thought that an interactive way to teach EKGs is the best method of teaching, and 73% did not feel confident interpreting EKGs. 30% often rely on automated EKG interpretation. Further analysis indicated that PGY-1 residents reported ordering fewer EKGs (correlation coefficient -0.399, p = 0.012) and were uncomfortable diagnosing QT prolongation on an EKG (correlation coefficient -0.310, p = 0.049). Residents in the third or greater year of training ordered more EKGs (correlation coefficient 0.379, p = 0.015), less frequently relied on the computer for EKG diagnosis (correlation coefficient 0.399, p = 0.010), and were comfortable diagnosing an acute myocardial infarction and atrial arrhythmias. CONCLUSIONS In conclusion, most IM trainees do not feel comfortable interpreting EKG, however, this does improve with PGY year. WhatsApp is a possible platform for teaching EKGs.

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Disseminated mycobacterial septicemia presented as acute abdomen: a surgeon’s perspective on Landouzy’s sepsis

BMJ Case Reports ◽

10.1136/bcr-2020-237574 ◽

2020 ◽

Vol 13 (12) ◽

pp. e237574

Author(s):

Lokesh Vellore Dasarathan ◽

Pranay Gaikwad ◽

Ramesh Babu Telugu

Keyword(s):

Bone Marrow ◽

Septic Shock ◽

Acute Abdomen ◽

Clinical Condition ◽

Cross Sectional ◽

Pulse Steroid Therapy ◽

Source Of Infection ◽

Antituberculosis Therapy ◽

Pulse Steroid ◽

Multi Organ Dysfunction Syndrome

A 20-year-old man presented in emergency with fever, abdominal pain and obstipation. On evaluation, he was found to have an acute abdomen with septic shock. The cross-sectional abdominal imaging revealed hepatosplenomegaly, pleural effusion and ascites with retroperitoneal lymphadenopathy. He was resuscitated and started on broad-spectrum antibiotics. There was no other source of infection identified elsewhere. While bacterial and fungal cultures were negative, the sputum, blood, bone marrow and ascitic fluid were positive for Mycobacterium tuberculosis following which he was started on antituberculosis therapy. Despite therapy, the patient’s clinical condition continued to deteriorate requiring critical care. In view of Landouzy’s sepsis, pulse steroid therapy was started. However, the patient’s clinical condition continued to deteriorate and developed systemic inflammatory response syndrome and multi-organ dysfunction syndrome. Despite the best efforts, the patient expired.

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Association between Blood Pressure and Serum Thyroid-Stimulating Hormone Concentration within the Reference Range: A Population-Based Study

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2006-2208 ◽

2007 ◽

Vol 92 (3) ◽

pp. 841-845 ◽

Cited By ~ 119

Author(s):

Bjørn O. Åsvold ◽

Trine Bjøro ◽

Tom I. L. Nilsen ◽

Lars J. Vatten

Keyword(s):

Blood Pressure ◽

Diastolic Blood Pressure ◽

Outcome Measures ◽

Odds Ratio ◽

Reference Range ◽

Positive Association ◽

Population Based ◽

Thyroid Stimulating Hormone ◽

Cross Sectional ◽

Population Based Study

Abstract Context: The association between thyroid function and blood pressure is insufficiently studied. Objective: The objective of the investigation was to study the association between TSH within the reference range and blood pressure. Design and Setting: This was a cross-sectional, population-based study. Subjects: A total of 30,728 individuals without previously known thyroid disease were studied. Main Outcome Measures: The main outcome measures were mean systolic and diastolic blood pressure and pulse pressure and odds ratio for hypertension (>140/90 mm Hg or current or previous use of antihypertensive medication), according to categories of TSH. Results: Within the reference range of TSH (0.50–3.5 mU/liter), there was a linear increase in blood pressure with increasing TSH. The average increase in systolic blood pressure was 2.0 mm Hg [95% confidence interval (CI) 1.4–2.6 mm Hg] per milliunit per liter increase in TSH among men, and 1.8 mm Hg (95% CI 1.4–2.3 mm Hg) in women. The corresponding increase in diastolic blood pressure was 1.6 mm Hg (95% CI 1.2–2.0 mm Hg) in men and 1.1 mm Hg (95% CI 0.8–1.3 mm Hg) in women. Comparing TSH of 3.0–3.5 mU/liter (upper part of the reference) with TSH of 0.50–0.99 mU/liter (lower part of the reference), the odds ratio for hypertension was 1.98 (95% CI 1.56–2.53) in men and 1.23 (95% CI 1.04–1.46) in women. Conclusion: Within the reference range of TSH, we found a linear positive association between TSH and systolic and diastolic blood pressure that may have long-term implications for cardiovascular health.

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Portuguese Patient Dignity Question: A cross-sectional study of palliative patients cared for in primary care

Palliative & Supportive Care ◽

10.1017/s1478951520000164 ◽

2020 ◽

Vol 18 (6) ◽

pp. 658-661

Author(s):

Mafalda Lemos Caldas ◽

Miguel Julião ◽

Ana João Santos ◽

Harvey Max Chochinov

Keyword(s):

Primary Care ◽

Health Care Providers ◽

Cross Sectional Study ◽

Care Providers ◽

Sectional Study ◽

Clinical Tool ◽

Cross Sectional ◽

Old Patients ◽

Promising Tool ◽

Palliative Patients

AbstractIntroductionThe Patient Dignity Question (PDQ) is a clinical tool developed with the aim of reinforcing the sense of personhood and dignity, enabling health care providers (HCPs) to see patients as people and not solely based on their illness.ObjectiveTo study the acceptability and feasibility of the Portuguese version of the PDQ (PDQ-PT) in a sample of palliative care patients cared for in primary care (PC).MethodA cross-sectional study using 20 palliative patients cared for in a PC unit. A post-PDQ satisfaction questionnaire was developed.ResultsTwenty participants were included, 75% were male; average age was 70 years old. Patients found the summary accurate, precise, and complete; all said that they would recommend the PDQ to others and want a copy of the summary placed on their family physician's medical chart. They felt the summary heightened their sense of dignity, considered it important that HCPs have access to the summary and indicated that this information could affect the way HCPs see and care for them. The PDQ-PT's took 7 min on average to answer, and 10 min to complete the summary.Significance of resultsThe PDQ-PT is well accepted and feasible to use with palliative patients in the context of PC and seems to be a promising tool to be implemented. Future trials are now warranted.

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The utility of strain imaging in the cardiac surveillance of bone marrow transplant patients

Heart ◽

10.1136/heartjnl-2021-319359 ◽

2021 ◽

pp. heartjnl-2021-319359

Author(s):

Tejas Deshmukh ◽

Peter Emerson ◽

Paul Geenty ◽

Shehane Mahendran ◽

Luke Stefani ◽

...

Keyword(s):

Bone Marrow ◽

Global Longitudinal Strain ◽

Group Versus ◽

Marrow Transplant ◽

Cross Sectional Study ◽

Left Ventricular ◽

Right Ventricular Free Wall ◽

Cross Sectional ◽

Allogenic Bone ◽

Transplant Patients

ObjectiveTo evaluate the utility of two-dimensional multiplanar speckle tracking strain to assess for cardiotoxicity post allogenic bone marrow transplantation (BMT) for haematological conditions.MethodsCross-sectional study of 120 consecutive patients post-BMT (80 pretreated with anthracyclines (BMT+AC), 40 BMT alone) recruited from a late effects haematology clinic, compared with 80 healthy controls, as part of a long-term cardiotoxicity surveillance study (mean duration from BMT to transthoracic echocardiogram 6±6 years). Left ventricular global longitudinal strain (LV GLS), global circumferential strain (LV GCS) and right ventricular free wall strain (RV FWS) were compared with traditionl parameters of function including LV ejection fraction (LVEF) and RV fractional area change.ResultsLV GLS (−17.7±3.0% vs −20.2±1.9%), LV GCS (−14.7±3.5% vs −20.4±2.1%) and RV FWS (−22.6±4.7% vs −28.0±3.8%) were all significantly (p=0.001) reduced in BMT+AC versus controls, while only LV GCS (−15.9±3.5% vs −20.4±2.1%) and RV FWS (−23.9±3.5% vs −28.0±3.8%) were significantly (p=0.001) reduced in BMT group versus controls. Even in patients with LVEF >53%, ~75% of patients in both BMT groups demonstrated a reduction in GCS.ConclusionMultiplanar strain identifies a greater number of BMT patients with subclinical LV dysfunction rather than by GLS alone, and should be evaluated as part of post-BMT patient surveillence. Reduction in GCS is possibly due to effects of preconditioning, and is not fully explained by AC exposure.

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Hidden bedside rationing in the Netherlands: a cross-sectional survey among physicians in internal medicine

BMC Health Services Research ◽

10.1186/s12913-021-06229-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ursula W. de Ruijter ◽

Hester F. Lingsma ◽

Willem A. Bax ◽

Johan Legemaate

Keyword(s):

Internal Medicine ◽

The Netherlands ◽

Patient Choice ◽

Cross Sectional Survey ◽

Online Questionnaire ◽

Cross Sectional ◽

Physician Characteristics ◽

Distribution Of Resources ◽

Healthcare Rationing ◽

Do So

Abstract Background Healthcare rationing can be defined as withholding beneficial care for cost reasons. One form in particular, hidden bedside rationing, is problematic because it may result in conflicting loyalties for physicians, unfair inequality among patients and illegitimate distribution of resources. Our aim is to establish whether bedside rationing occurs in the Netherlands, whether it qualifies as hidden and what physician characteristics are associated with its practice. Methods Cross-sectional online questionnaire on knowledge of -, experience with -, and opinion on rationing among physicians in internal medicine within the Dutch healthcare system. Multivariable ordinal logistic regression was used to explore relations between hidden bedside rationing and physician characteristics. Results The survey was distributed among 1139 physicians across 11 hospitals with a response rate of 18% (n = 203). Most participants (n = 129; 64%) had experience prescribing a cheaper course of treatment while a more effective but more expensive alternative was available, suggesting bedside rationing. Subsequently, 32 (24%) participants never disclosed this decision to their patient, qualifying it as hidden. The majority of participants (n = 153; 75%) rarely discussed treatment cost. Employment at an academic hospital was independently associated with more bedside rationing (OR = 17 95%CI 6.1–48). Furthermore, residents were more likely to disclose rationing to their patients than internists (OR = 3.2, 95%CI 2.1–4.7), while salaried physicians were less likely to do so than physicians in private practice (OR = 0.5, 95%CI 0.4–0.8). Conclusion Hidden bedside rationing occurs in the Netherlands: patient choice is on occasion limited with costs as rationale and this is not always disclosed. To what extent distribution of healthcare should include bedside rationing in the Netherlands, or any other country, remains up for debate.

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