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Vol 4, No 4 (2011)
ORIGINAL PAPERS
Published online: 2012-01-05
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Evaluation of diagnostic value of reticulated platelet testing in patients with primary immune thrombocytopenia

Krystyna Maślanka, Anna Sikorska, Andrzej Misiak, Agnieszka Wróbel, Halina Michur, Monika Prochorec-Sobieszek, Patrycja Łopacz, Ewa Brojer
Journal of Transfusion Medicine 2011;4(4):159-165.

open access

Vol 4, No 4 (2011)
ORIGINAL PAPERS
Published online: 2012-01-05

Abstract

Background: The basic criterion for primary immune thrombocytopenia (ITP) diagnosis is decreased platelet count (< 100 × 109/l) with no other causes for thrombocytopenia. Elevated megakaryocyte count in bone marrow is a helpful parameter for ITP recognition. As bone marrow biopsy is an invasive procedure the evaluation of megakaryocyte activity through examination of reticulated platelets (RP) seems to be a better diagnostic option. The aim of the study was to assess the diagnostic value of RP tests in ITP patients.
Material and methods: Reticulated placelets were tested in 56 ITP patients. The mean platelet count before treatment was 27.5 ± 15.8 × 109/l. In this group of patients 26 were treated only pharmacologically and 30 were subjected to splenectomy. The monitoring period was 1–3 years. Treatment was considered satisfactory when platelet count exceeded 50 × 109/l. Reticulated placelets were isolated from platelet-rich plasma and fixed in 1% paraformaldehyde, then stained with anti CD41-PE monoclonal antibody and thiazole orange. The RP values were evaluated in flow cytometer. The RP values in ITP patients were compared to RP values for healthy donors (1.3%, range: 0.5–6%). Values above 10% were considered elevated.
Results: The RP percentage prior to treatment was 18.5% (significantly higher than in healthy donors). In the course of pharmacological regime we observed a decrease of RP percentage in 11 patients (8.8 ± 7.4%) responsive to treatment which correlated with the increase of platelet count (123.8 ± 72.7 × 109/l). In 15 other patients unresponsive to such treatment, the percentage of RP remained elevated (24.7% ± 20.6%) and platelet counts were < 50 × 109/l. In 29 of the 30 splenectomy patients, platelet counts were observed to increase (mean; 307 ± 170 × 109/l) on days 3–5 following surgery while the RP percentage remained elevated (16.9 ± ± 7.8%). In 1 splenectomy patient the platelet count did not increase and the RP percentage remained high. In 12 of the 15 patients who reported for control visits after splenectomy the percentage of RP was still elevated and platelet counts did not exceed 30 × 109/l.
Conclusions: The clinical ITP diagnosis is confirmed by the elevated RP values which correlate with lower platelet counts. Reticulated placelets investigation is an additional parameter of effective ITP treatment.
J. Transf. Med. 2011; 4: 159–165

Abstract

Background: The basic criterion for primary immune thrombocytopenia (ITP) diagnosis is decreased platelet count (< 100 × 109/l) with no other causes for thrombocytopenia. Elevated megakaryocyte count in bone marrow is a helpful parameter for ITP recognition. As bone marrow biopsy is an invasive procedure the evaluation of megakaryocyte activity through examination of reticulated platelets (RP) seems to be a better diagnostic option. The aim of the study was to assess the diagnostic value of RP tests in ITP patients.
Material and methods: Reticulated placelets were tested in 56 ITP patients. The mean platelet count before treatment was 27.5 ± 15.8 × 109/l. In this group of patients 26 were treated only pharmacologically and 30 were subjected to splenectomy. The monitoring period was 1–3 years. Treatment was considered satisfactory when platelet count exceeded 50 × 109/l. Reticulated placelets were isolated from platelet-rich plasma and fixed in 1% paraformaldehyde, then stained with anti CD41-PE monoclonal antibody and thiazole orange. The RP values were evaluated in flow cytometer. The RP values in ITP patients were compared to RP values for healthy donors (1.3%, range: 0.5–6%). Values above 10% were considered elevated.
Results: The RP percentage prior to treatment was 18.5% (significantly higher than in healthy donors). In the course of pharmacological regime we observed a decrease of RP percentage in 11 patients (8.8 ± 7.4%) responsive to treatment which correlated with the increase of platelet count (123.8 ± 72.7 × 109/l). In 15 other patients unresponsive to such treatment, the percentage of RP remained elevated (24.7% ± 20.6%) and platelet counts were < 50 × 109/l. In 29 of the 30 splenectomy patients, platelet counts were observed to increase (mean; 307 ± 170 × 109/l) on days 3–5 following surgery while the RP percentage remained elevated (16.9 ± ± 7.8%). In 1 splenectomy patient the platelet count did not increase and the RP percentage remained high. In 12 of the 15 patients who reported for control visits after splenectomy the percentage of RP was still elevated and platelet counts did not exceed 30 × 109/l.
Conclusions: The clinical ITP diagnosis is confirmed by the elevated RP values which correlate with lower platelet counts. Reticulated placelets investigation is an additional parameter of effective ITP treatment.
J. Transf. Med. 2011; 4: 159–165
Get Citation

Keywords

primary immune thrombocytopenia; reticulated platelet; usefulness of reticulated platelet testing

About this article
Title

Evaluation of diagnostic value of reticulated platelet testing in patients with primary immune thrombocytopenia

Journal

Journal of Transfusion Medicine

Issue

Vol 4, No 4 (2011)

Pages

159-165

Published online

2012-01-05

Bibliographic record

Journal of Transfusion Medicine 2011;4(4):159-165.

Keywords

primary immune thrombocytopenia
reticulated platelet
usefulness of reticulated platelet testing

Authors

Krystyna Maślanka
Anna Sikorska
Andrzej Misiak
Agnieszka Wróbel
Halina Michur
Monika Prochorec-Sobieszek
Patrycja Łopacz
Ewa Brojer

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