Application Of Peripheral Blood Reticulated Platelets In Immune Thrombocytopenic Purpura's Diagnosis And Treatment

Immune thrombocytopenic purpura(ITP)is an acquired autoimmune hematological diseases,with an accelerated peripheral platelet destruction.The clinical manifestations are often accompanied by skin and mucous membrane,purpura,ecchymosis,epistaxis and gingival bleeding.Reticulated platelet(RP),also named immature platelet fraction(IPF),are newly formed platelets that considered as markers for bone marrow thrombopoiesis,and has an important association with ITP.Objectives: We aimed to evaluate the value of reticulated platelet and it's related parameters(reticulated platelet ratio and activation function)in ITP diagnosis,differential diagnosis and efficacy monitoring,help to guide the clinical adjustment of patients' drugs dosage,and to provide an effective laboratory indicators for optimizing the clinical diagnosis and treatment of ITP.Methods: 83 newly diagnosed ITP patients,59 non ITP thrombocytopenia patients,and 237 healthy controls were included to check the efficacy of IPF% on diagnosing and differentiating ITP.Another 143 follow-up ITP patients were included to evaluated IPF% changes over treatment.IPF% of newly diagnosed and follow-up ITP patients were assessed by the automatic hematology analyzer,to clarify its role in ITP patients' efficacy monitoring.20 ITP patients and 30 healthy controls were enrolled to investigated RP percentage(RP%)and platelet activation(CD62P expression level)used flow cytometry,by comparing the results between the above two groups,we preliminarily determined the effect of platelet activation on bleeding tendency of ITP patients.Results: ITP patients performed increased IPF% than every group of non-immune thrombocytopenia and healthy individuals(P<0.01).In addition,flow cytometry results showed that the expression of CD62P(positive rate and mean fluorescence intensity)in mature platelets among ITP patients was higher than normal controls,and reticulated platelets were significantly higher in the ITP group(p <0.001).It suggested that ITP patients performed decreased platelet counts but weak bleeding may be associated with the increased platelet activation.Platelet counts showed an gradually increase in follow-up ITP patients with treatment while IPF% decreased until reached the normal level.Significant negative correlation was seen between the two parameters(r=-0.336,P<0.001).However,in this study,PLT counts in three cases of poor prognosis showed abnormally fluctuation during high IPF% period,suggesting that IPF% is another important noninvasive monitoring index in ITP patients' efficacy monitoring in addition to platelet parameters.Conclusion: IPF% can help to diagnose and differentiate the disease of ITP.The reticulated platelets,performed an increased activation in ITP patients than normal controls,might in part explain the weak blooding on clinical of ITP.Finally,in addition to the platelet counts,IPF% could be regarded as an essential parameter in evaluating the therapeutic effects of follow-up ITP patients and guide the dynamic adjustment of drug.