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Beyond the platelet count: immature platelet fraction and thromboelastometry correlate with bleeding in patients with immune thrombocytopenia
Author(s) -
Greene Lindsey A.,
Chen Siqi,
Seery Caroline,
Imahiyerobo Allison M.,
Bussel James B.
Publication year - 2014
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.12929
Subject(s) - thromboelastometry , medicine , platelet , gastroenterology , mean platelet volume , pathophysiology , immunology
Summary Platelet counts ( PC ) estimate bleeding risk in Immune Thrombocytopenia ( ITP ). We investigated whether measures of thromboelastometry and absolute immature platelet fraction (A‐ IPF ) would correlate better with acute bleeding score ( ABS ) than PC or mean platelet volume ( MPV ). Simultaneous determination of ABS , complete blood count and thromboelastometry was performed in 141 ITP patients; 112 underwent A‐ IPF testing. Subgroup analyses were performed for paediatric subjects, PC <60 × 10 9 /l and <30 × 10 9 /l. PC significantly inversely correlated with ABS in all subjects, PC <30 × 10 9 /l and total paediatric cohort. MPV did not correlate with ABS in any subgroup. Thromboelastometry measures of clot firmness, but not PC , significantly correlated with ABS in all subjects with PC <60 × 10 9 /l, and children with PC <60 × 10 9 /l and <30 × 10 9 /l. A‐ IPF demonstrated stronger correlation with ABS than did PC among all subjects, those with PC <60 × 10 9 /l, all children and children with PC <30 × 10 9 /l ( r = −0·37; r = −0·34; r = −0·44; r = −0·60) versus ABS with PC (r = −0·36; ns ; r = −0·32; ns ). Stronger correlations of both thromboelastometry measures of clot firmness and A‐ IPF than PC with ABS suggest factors beyond PC , i.e . related to platelet function, contribute to ITP bleeding pathophysiology. Thromboelastometry, A‐ IPF and ABS can be incorporated into routine or acute visits.