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      Reference interval for immature platelet fraction on Sysmex XN haematology analyser in adult population

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          Abstract

          Introduction

          The Sysmex XN-series haematology analyser has newly adopted a fluorescent channel to measure immature platelet fraction (IPF). To promote the clinical utility of this promising parameter, establishing a reliable reference interval is mandatory. According to previous studies, IPF values may be affected by the employed analyser and the ethnic background of the individual, but no differences seem to be found between individuals’ genders. Therefore, this study aimed to define the reference interval for IPF in a Spanish population following Clinical and Laboratory Standard Institute (CLSI) guidelines.

          Materials and methods

          A total of 153 healthy Caucasian adults from Spain met the inclusion criteria. IPF measurement was performed by means of a Sysmex XN-2000 haematology analyser. A non-parametric percentile method was used to calculate the reference intervals in accordance with CLSI guidelines.

          Results

          The obtained reference interval for IPF on the Sysmex XN-2000 was 1.6–9.6% (90% confidence intervals (CIs) were 1.5–1.8 and 9.3–11.5, respectively). No significant gender difference in IPF reference intervals was observed (P = 0.101).

          Conclusions

          This study provides, for the first time, a reference interval for IPF using a Sysmex XN-2000 in a Spanish population, ranging from 1.6 to 9.6%. These data are needed to evaluate platelet production in several conditions such as thrombocytopenia, inflammatory states and cardiovascular diseases, as well as for future research.

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          Most cited references17

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          Assessment of an immature platelet fraction (IPF) in peripheral thrombocytopenia.

          A new automated method to reliably quantify reticulated platelets, expressed as the immature platelet fraction (IPF), has been developed utilizing the XE-2100 blood cell counter with upgraded software (Sysmex, Kobe, Japan). The IPF is identified by flow cytometry techniques and the use of a nucleic acid specific dye in the reticulocyte/optical platelet channel. The clinical utility of this parameter was established in the laboratory diagnosis of thrombocytopenia due to increased peripheral platelet destruction, particularly autoimmune thrombocytopenic purpura (AITP) and thrombotic thrombocytopenic purpura (TTP). Reproducibility and stability results over 48 h were good. An IPF reference range in healthy individuals was established as 1.1-6.1%, with a mean of 3.4%. Patients in whom platelet destruction might be abnormal, were studied and two of these patients followed serially during the course of treatment. The IPF was raised in several disease states. The most significant increases in IPF values were found in patients with AITP (mean 22.3%, range 9.2-33.1%) and acute TTP (mean 17.2%, range 11.2-30.9%). Following patients during treatment demonstrated that as the platelet count recovered the IPF% fell. These results show that a rapid, inexpensive automated method for measuring the IPF% is feasible and should become a standard parameter in evaluating the thrombocytopenic patient.
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            Reticulated platelets: analytical aspects and clinical utility.

            Reticulated platelets are immature platelets circulating in blood; they reflect the activity of megakaryopoiesis in the bone marrow. Therefore, they can be used as a non-invasive test in patients with thrombocytopenia in various clinical conditions. The preferred method of analysis is by flow cytometry. However, there is an evident lack of analytical standardization, making it difficult to compare results obtained in different laboratories. Currently, two types of hematology analyzers are on the market offering fully automated measurement of reticulated or immature platelets: the high end analyzers manufactured by Sysmex (XE- and XN-series) and Abbott (CELL-DYN Sapphire). Although the methods are essentially different and cannot be used interchangeably, both have been proven to have clinical utility. Reticulated or immature platelet assays are useful for the differential diagnosis of thrombocytopenia and for monitoring bone marrow recovery after chemotherapy or stem cell transplantation. These assays may aid clinicians in platelet transfusion decisions when recovery from thrombocytopenia is imminent. In addition, preliminary findings indicate that there is a rationale for reticulated or immature platelets for risk stratification in acute coronary syndromes and for monitoring the effect of treatment with antiplatelet drugs in patients with coronary artery diseases. The aim of this paper is to present the present technology available for measuring reticulated platelets as well as an overview of the current status of clinical application. This overview also indicates that more research is needed before reticulated or immature platelet assays can be applied in other clinical conditions than thrombocytopenia and after transplantation.
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              Association of immature platelets with adverse cardiovascular outcomes.

              Immature platelets are less responsive to the effects of antiplatelet drugs and contain messenger ribonucleic acid that is translationally active. They can be measured easily using an automated hematoanalyzer and reported as part of the complete blood count.
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                Author and article information

                Journal
                Biochem Med (Zagreb)
                Biochem Med (Zagreb)
                BM
                Biochemia Medica
                Croatian Society of Medical Biochemistry and Laboratory Medicine
                1330-0962
                1846-7482
                15 February 2018
                15 February 2018
                15 February 2018
                : 28
                : 1
                : 010708
                Affiliations
                [1 ]Clinical Laboratory, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
                [2 ]Critical Care Unit, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
                Author notes
                Article
                bm-28-1-010708
                10.11613/BM.2018.010708
                5812701
                29472803
                35175c5a-ce3b-4111-8b82-e02a7f6133fc
                ©Croatian Society of Medical Biochemistry and Laboratory Medicine.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution ( http://creativecommons.org/licenses/by/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 21 September 2017
                : 07 January 2018
                Categories
                Original Papers

                platelets,haematology,reference values,immature platelet fraction

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