Beyond the platelet count: immature platelet fraction and thromboelastometry correlate with bleeding in patients with immune thrombocytopenia

作者：Greene Lindsey A^*; Chen Siqi; Seery Caroline; Imahiyerobo Allison M; Bussel James B

来源：British Journal of Haematology, 2014, 166(4): 592-600.

DOI：10.1111/bjh.12929

• immature platelet fraction
• thromboelastometry
• immune thrombocytopenia (ITP)
• platelet
• paediatric

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 x 10(9)/l and <30 x 10(9)/l. PC significantly inversely correlated with ABS in all subjects, PC <30 x 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 x 10(9)/l, and children with PC <60 x 10(9)/l and <30 x 10(9)/l. A-IPF demonstrated stronger correlation with ABS than did PC among all subjects, those with PC <60 x 10(9)/l, all children and children with PC <30 x 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.

• 出版日期2014-8