Skip to main content
SpringerLink
Log in

Clinical significance of IPF% or RP% measurement in distinguishing primary immune thrombocytopenia from aplastic thrombocytopenic disorders

  • Original Article
  • Published:
International Journal of Hematology Aims and scope Submit manuscript

Abstract

The diagnosis of primary immune thrombocytopenia (ITP) is based on differential diagnosis. Although the measurement of percentages of reticulated platelets (RP%) by flow cytometry is useful as a supportive diagnostic test, this method is nonetheless a time-consuming, laboratory-based assay. To identify alternative assays that are useful in daily practice, we compared three methods in parallel, IPF% measured by XE-2100 [IPF% (XE), Sysmex Corp.], IPF% measured by new XN-1000 [IPF% (XN)], and RP%. We examined 47 patients with primary ITP, 28 patients with aplastic thrombocytopenia (18 aplastic anemia and 10 chemotherapy-induced thrombocytopenia) and 80 healthy controls. In a selected experiment, we examined 16 patients with paroxysmal nocturnal hemoglobinuria (PNH) to examine the effect of hemolysis. As compared with IPF% (XE), IPF% (XN) showed better within-run reproducibility. The sensitivity and specificity for the diagnosis of ITP were 83.0 and 75.0 % for IPF% (XE), 85.1 and 89.3 % for IPF% (XN), and 93.6 and 89.3 % for RP%, respectively. Examination of PNH patients revealed that hemolysis and/or red blood cell fragments interfered with IPF% (XE) values, but not with IFP % (XN) values. Our results suggest that IPF% measured by XN-1000 may be of comparable value with RP% as a supportive diagnostic test for ITP.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Cines DB, Blanchette VS. Immune thrombocytopenic purpura. N Engl J Med. 2002;346:995–1008.

    Article  PubMed  Google Scholar 

  2. McMillan R. The pathogenesis of chronic immune thrombocytopenic purpura. Semin Hematol. 2007;44:S3–11.

    Article  CAS  PubMed  Google Scholar 

  3. Kashiwagi H, Tomiyama Y. Pathophysiology and management of primary immune thrombocytopenia. Int J Hematol. 2013;98:24–33.

    Article  CAS  PubMed  Google Scholar 

  4. Rodeghiero F, Stasi R, Gernsheimer T, Michel M, Provan D, Arnold DM, et al. Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood. 2009;113:2386–93.

    Article  CAS  PubMed  Google Scholar 

  5. Brighton TA, Evans S, Castaldi PA, Chesterman CN, Chong BH. Prospective evaluation of the clinical usefulness of an antigen specific assay (MAIPA) in idiopathic thrombocytopenic purpura and other immune thrombocytopenias. Blood. 1996;88:194–201.

    CAS  PubMed  Google Scholar 

  6. McMillan R, Wang L, Tani P. Prospective evaluation of the immunobead assay for the diagnosis of adult chronic immune thrombocytopenic purpura (ITP). J Thromb Haemost. 2003;1:485–91.

    Article  CAS  PubMed  Google Scholar 

  7. Tomiyama Y, Kosugi S. Autoantigenic epitopes on platelet glycoproteins. Int J Hematol. 2005;81:100–5.

    Article  CAS  PubMed  Google Scholar 

  8. Kosugi S, Kurata Y, Tomiyama Y, Tahara T, Kato T, Tadokoro S, et al. Circulating thrombopoietin level in chronic immune thrombocytopenic purpura. Br J Haematol. 1996;93:704–6.

    Article  CAS  PubMed  Google Scholar 

  9. Emmons RV, Reid DM, Cohen RL, Meng G, Young NS, Dunbar CE, et al. Human thrombopoietin levels are high when thrombocytopenia is due to megakaryocyte deficiency and low when due to increased platelet destruction. Blood. 1996;87:4068–71.

    CAS  PubMed  Google Scholar 

  10. Kurata Y, Hayashi S, Kiyoi T, Kosugi S, Kashiwagi H, Honda S, et al. Diagnostic value of tests for reticulated platelets, plasma glycocalicin, and thrombopoietin levels for discriminating between hyperdestructive and hypoplastic thrombocytopenia. Am J Clin Pathol. 2001;115:656–64.

    Article  CAS  PubMed  Google Scholar 

  11. Kienast J, Schmitz G. Flow cytometric analysis of thiazole orange uptake by platelets: a diagnostic aid in the evaluation of thrombocytopenic disorders. Blood. 1990;75:116–21.

    CAS  PubMed  Google Scholar 

  12. Richards EM, Baglin TP. Quantitation of reticulated platelets: methodology and clinical application. Br J Haematol. 1995;91:445–51.

    Article  CAS  PubMed  Google Scholar 

  13. Kuwana M, Kurata Y, Fujimura K, Fujisawa K, Wada H, Nagasawa T, et al. Preliminary laboratory based diagnostic criteria for immune thrombocytopenic purpura: evaluation by multi-center prospective study. J Thromb Haemost. 2006;4:1936–43.

    Article  CAS  PubMed  Google Scholar 

  14. Barsam SJ, Psaila B, Forestier M, Page LK, Sloane PA, Geyer JT, et al. Platelet production and platelet destruction: assessing mechanisms of treatment effect in immune thrombocytopenia. Blood. 2011;117:5723–32.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  15. Hayashi S, Nishiyama M, Suehisa E, Kashiwagi H, Kurata Y, Tomiyama Y. Comparison between two methods for the measurement reticulated platelet and their clinical significance—flow cytometry (FCM) method and IPF method using automated hematology analyzer (XE-2000). Rinsho Byori. 2009;57:1039–44.

    PubMed  Google Scholar 

  16. International agranulocytosis and aplastic anemia study. Incidence of aplastic anemia: the relevance of diagnostic criteria. By the International Agranulocytosis and Aplastic Anemia Study. Blood. 1987;70:1718–21.

    Google Scholar 

  17. van der Linden N, Klinkenberg LJ, Meex SJ, Beckers EA, de Wit NC, Prinzen L. Immature platelet fraction measured on the Sysmex XN hemocytometer predicts thrombopoietic recovery after autologous stem cell transplantation. Eur J Haematol. 2014;93:150–6.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Junt T, Schulze H, Chen Z, Massberg S, Goerge T, Krueger A, et al. Dynamic visualization of thrombopoiesis within bone marrow. Science. 2007;317:1767–70.

    Article  CAS  PubMed  Google Scholar 

  19. Zhang L, Orban M, Lorenz M, Barocke V, Braun D, Urtz N, et al. A novel role of sphingosine 1-phosphate receptor S1pr1 in mouse thrombopoiesis. J Exp Med. 2012;209:2165–81.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  20. Kienast J, Schmitz G. Flow cytometric analysis of thiazole orange uptake by platelets: a diagnostic aid in the evaluation of thrombocytopenic disorders. Blood. 1990;75:116–21.

    CAS  PubMed  Google Scholar 

  21. Tanaka Y, Tanaka Y, Gondo K, Maruki Y, Kondo T, Asai S, et al. Performance evaluation of platelet counting by novel fluorescent dye staining in the XN-series automated hematology analyzers. J Clin Lab Anal. 2014;28:341–8.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported by Grant-in Aid for Scientific Research from the Ministry of Education, Culture, Sports, Science and Technology in Japan and the Ministry of Health, Labor and Welfare in Japan.

Conflict of interest

Automated hematology analyzers, XE-2100 and XN-1000, were supplied by Sysmex Corp. During this study the authors have no other COI to declare.

Author information

Authors and Affiliations

  1. Department of Blood Transfusion, Osaka University Hospital, Suita, Osaka, 565-0871, Japan

    Mikiko Sakuragi, Satoru Hayashi, Tomoko Kiyokawa, Keisuke Nagamine, Hisashi Kato & Yoshiaki Tomiyama

  2. Laboratory for Clinical Investigation, Osaka University Hospital, Suita, Osaka, Japan

    Miho Maruyama & Osamu Kabutomori

  3. Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan

    Hisashi Kato, Hirokazu Kashiwagi, Yuzuru Kanakura & Yoshiaki Tomiyama

Authors
  1. Mikiko Sakuragi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Satoru Hayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Miho Maruyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Osamu Kabutomori
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tomoko Kiyokawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Keisuke Nagamine
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hisashi Kato
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hirokazu Kashiwagi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Yuzuru Kanakura
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Yoshiaki Tomiyama
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yoshiaki Tomiyama.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sakuragi, M., Hayashi, S., Maruyama, M. et al. Clinical significance of IPF% or RP% measurement in distinguishing primary immune thrombocytopenia from aplastic thrombocytopenic disorders. Int J Hematol 101, 369–375 (2015). https://doi.org/10.1007/s12185-015-1741-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12185-015-1741-0

Keywords

Search

Navigation