Immature platelet fraction in children infected with dengue fever

Amrutha B. S., Adarsh E., SreeKrishna Y., Apoorva Naidu, Shivtej N.


Background: Millions are infected with dengue every year.  Early diagnosis of dengue infection is important for proper treatment of DHF and DSS to avoid fatal outcome. Thrombocytopenia is a common hematological abnormality in dengue, which demands platelet transfusion in most of the severe dengue cases. Platelet transfusion though life-saving has its own hazards. Hence, we can use some new parameter like immature platelet fraction (IPF) which is a measure of reticulated platelets that reflects the rate of thrombopoiesis. The risk of platelet transfusion may be decreased by rapid identification of immature platelet fraction. This study was performed to establish reference of IPF values for the assessment of thrombopoiesis.

Methods: Blood samples from 150 children were obtained on day of illness 3, 5 and 7. The IPF is identified by sysmex XE2100 hematology analyser in the reticulocyte channel using a fluorescent dye and a carefully designed gating system and counted by a special software termed IPF master7. IPF values against platelet count were assessed separately on day 3, 5 and 7.

Results: The reference intervals of IPF > 8 % and IPF < 8 % were assessed against platelet count. Increase in IPF favored increase in platelet count on day 5 which was statistically significant with the p value <0.001.

Conclusions: A rapid and inexpensive automated measurement of IPF can be integrated as a standard parameter to evaluate the thrombopoietic state of the bone marrow. From the study it can be concluded that IPF is an important predictor of increase in platelet count.  Increase in IPF>8 % suggests that platelet count will be increased in next 24 to 48hrs indicating that further blood transfusion will not be required.


Blood transfusion, Dengue hemorrhagic fever (DHF), Dengue shock syndrome (DSS), Immature platelet fraction (IPF), Platelet count

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Guzman MG, Sierra B, Kouri G, Farrar J, Simmons C. Host and virus determinants of susceptibility and dengue disease severity. In: Hanley KA, Weaver SC, editors. Frontiers in dengue virus research.Norfolk, UK: Caister Academic Press; 2010. pp. 79–102.

WHO. Geneva: World Health Organization; 2009. Dengue: guidelines for diagnosis, treatment, prevention and control – New ed.

Beatty ME, Hunsperger E, Long E, Schürch J, Jain S, Colindres R, Lerebours G, Bernard YM, Dobbins JG, Brown M, Clark GG. Mosquitoborne infections after Hurricane Jeanne, Haiti, 2004. Emerg Infect Dis. 2007;13(2):308-10.

Morrison AC, Minnick SL, Rocha C, Forshey BM, Stoddard ST, Getis A, Focks DA, Russell KL, Olson JG, Blair PJ, Watts DM, Sihuincha M, Scott TW, Kochel TJ. Epidemiology of dengue virus in Iquitos, Peru 1999 to 2005: interepidemic and epidemic patterns of transmission. PLoSNegl Trop Dis. 2010;4(5):e670.

Guy B, Saville M, Lang J. Development of Sanofi Pasteur tetravalent dengue vaccine. Hum Vaccin. 2010;6(9):696-705.

Coller BA, Clements DE. Dengue vaccines: progress and challenges. CurrOpin Immunol. 2011;23(3):391-8.

National vector born diseases control program. Available at

Fujimoto DE, KoifmanS.. Clinical and laboratory characteristics of patientswith dengue hemorrhagic fever manifestations and their transfusion profile. Re Bras Hematol Hemoter 2014;36(2):115-20.

Singhi S, Kissoon N, Bansal A. Dengue and dengue hemorrhagic fever: management issues in an intensive care unit. J Pediatr (Rio J)2007;83(2 Suppl):S22-35.

Dengue Fever Testing Available online at

Jung H, Jeon HK, Kim HJ, Kim SH. Immature platelet fraction: establishment of a reference interval and diagnostic measure for thrombocytopenia. Korean J Lab Med 2010;30(5): 451-9.

Dadu T, Sehgal K, Joshi M, KhodaijiS.. Evaluation of the immature platelet fraction as an indicator of platelet recovery in dengue patients. Int J Lab Hematol. 2014;36(5):499-504.

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(2):101-9

Briggs C. Quality counts: new parameters in blood cell counting. Int J Lab Hematol. 2010;31(3):277-97.

Ingram M, Coopersmith A. Reticulated platelets following acute blood loss. Br J Haematol. 1969;17(3):225-9.

Gaddis, ML, Gaddis, GM. Introduction to biostatistics: Part 4, Statistical inference techniques in hypothesis testing. Ann Emerg Med. 1990;19(7):820-5.

Patra P. Sample size in clinical research, the number we need. Int J Med Sci Public Health. 2012;1:5-9.

Sunder Rao P S S, Richard J (2006) : An Introduction to Biostatistics, A manual for students in health sciences , New Delhi: Prentice hall of India. 4th ed, 86-160.

Elenbaas, RM, Elenbaas, JK, Cuddy, PG. Evaluating the medical literature, part II: Statistical analysis.AnnEmerg Med. 1983;12(10):610-20.

Gan VC, Dengue: Moving from Current Standard of Care to State-of-the-Art Treatment. Curr Treat Options Infect Dis. 2014;6(3):208-26.

Osei-Bimpong A. The effect of storage on the clinical utility of the immature platelet fraction. Hematol. 2009;14(2):118-21.

Makroo RN, Raina V, Kumar P, Kanth RK. Role of platelet transfusion in the management of dengue patients in a tertiary care hospital. Asian J Transfus Sci. 2007;1(1):4.