Confirming that they have by now received 500 dengue patients in OPD and more than 300 in IPD, Sir Gangaram Hospital is now offering the latest technique of IPF or Immature Platelet Fraction testing in dengue patients with low platelet counts at a mere cost of Rs 450.
The main haematological abnormalities in dengue are thrombocytopenia and leucopenia. Thrombocytopenia is often symptomatic demanding platelet transfusion. As there is inherent risk associated with platelet transfusion , it is imperative to define precise criteria and transfusion trigger for platelets in Dengue patients .Immature platelets are recently released young platelets from bone marrow of dengue patients . The Immature Platelet Fraction (IPF %) is raised in diseases where there is increased platelet destruction and consumption , as it happens in case of dengue patients. It is decreased in bone marrow failure . The IPF % can predict the timing of platelet recovery .
According to Dr Jyoti Kotwal , Chairperson , Department of Haematology and Clinical Pathology , Sir Ganga Ram Hospital , “We have used this diagnostic modality in the paediatric patients of Dengue this season . We found that range of normal IPF at SGRH using 100 normal individuals is 0 to 7.25 % . Thus if IPF % is more than 7.25 % , it means younger re-generating platelets are present and once it crosses 10 % , it is likely that platelets will increase over next few hours .
According to Dr Dhiren Gupta , Senior Consultant , Paediatric Intensive Care , Sir Ganga Ram Hospital , “As per the present WHO guidelines platelet transfusion is not indicated in a stable dengue patients even if platelet count is less than 10000 . With the availability of new parameter like IPF , very likely that we can predict rise in platelets in a given dengue patients . This parameter has helped us in avoiding un-necessary platelet transfusion in few paediatric dengue patients . This is an upcoming marker which can be further developed .”
In one of the studies done on IPF , it was observed that 93.75 % of patients show platelet recovery within 24-48 hours if the IPF was greater than 10 % ( Int J Lab Hematol. 2014 Oct;36(5);499-504 Evaluation of the immature platelet fraction as an indicator of platelet recovery in dengue patients)
Two Case Studies:
- 12 year old female – 6 th day of illness with dropping platelets to 11000 . Child was hemodynamically stable with increasing IPF from 6-12 % . Over next 8 hours , platelet started rising rapidly . In next 12 hours it rose to 22000 . The platelets were kept ready but not transfused . Child was saved and discharged .
- 6 year old – 6th day of illness with platelet dropping to 15000 and evidence of bleeding and hypotension . IPF was 4.5 % . Platelet Concentration was immediately transfused . Next 12 hours child became stable and IPF rose to 11 % . Child was saved and discharged .
These are two case studies highlighting the importance of IPF . There are other patients on whom this technique has been tried this dengue season with positive results
Dr Jyoti Kotwal added , “Dengue season calls for platelet transfusion , sometimes inappropriate also . Careful clinical watchand monitoring platelet count may help to group the patients under risk category. Immature Platelet Fraction is a parameter that can be monitored to predict platelet recovery , so that platelet transfusion can be avoided , cost be saved and also the hazards associated with transfusion can also be avoided .It holds a great promise of becoming a reliable future guide for decisions concerning platelet transfusions”