IMMATURE PLATELET FRACTION

I am new to the website having just joined PDSA and also attended the PDSA conference in Chandler late July 2017. I have had slowly dropping platelet counts for 10+ years and for the past year and a half, it has been around 30. My hematologist has proposed no therapy as I have no major bruising, petechiae, nor blood blisters in the mouth. My life is very normal and red count is fine, white is slightly low (3-4). I have had four bone marrow biopsies as the first had a "false" reading indicating a chromosome 7 deletion, but this was not confirmed in any of the future biopsies. The fourth was just a year ago.
My hematologist suggested I do an Immature Platelet Fraction test indicating the percentage of platelets that are "immature", or very young. My percentage came out to be 20-30% (I ran the test twice) where normally it should be 4-6%. I believe this indicates the bone marrow is doing it's job making platelets, but they are being destroyed by autoimmune / antibodies in the blood stream. Comments?
I have seen nothing on this website about the importance/meaning of the Immature Platelet Fraction test, and also the meaning of Mean Platelet Volume ( mine is 13-14) although I think it refers to the platelets being very young (then destroyed?). Also, can I assume the young, large platelets are much more effective in plugging any holes in the vessels than the older ones are?
Appreciate any comments.

I've never heard of that test. Apparently, it isn't a common test.

I wouldn't necessarily assume that you only have a problem with destruction. I'd say that is a good probability, but I've read some articles from Blood Journal that indicate that most people with ITP have both things going on. There are ways to test, but they are only done for research purposes now and the tests are not available to the public yet. Have you had any antibody tests done?

We do discuss the Mean Platelet Volume here occasionally. It is generally elevated in patients with ITP and yes, it means that there are young, large platelets which are better at clotting than older, smaller ones. Many people with ITP also have Platelet Microparticles, which are very small, fragmented platelets. They are too small to be counted and also contribute to aid in clotting. This could actually be part of the reason that ITP can be a thrombotic disorder as well as a bleeding disorder.

I'm glad you haven't had to treat yet. That can be a nightmare. Hopefully, you can continue on without it.

Thank you for your inputs. I have not had antibody tests - can anyone recommend anything here?

PROESCHOLDT wrote: ... I have had slowly dropping platelet counts for 10+ years and for the past year and a half, it has been around 30 ... I have no major bruising, petechiae, nor blood blisters in the mouth.
... Also, can I assume the young, large platelets are much more effective in plugging any holes in the vessels than the older ones are?

Something to think about.
Realize that when some folks are stricken with ITP will have overt symptoms. Others, like you, have no petechia or mouth blister symptoms. Yet both ITPer's have 'young' platelets. So what is the difference to cause a symptom difference?

Well, one commonly reported difference here is that one ITPer has developed low counts slowly over an extended period of time, and in another, ITP has developed quickly. The difference seems like one's body is capable of making some sort of physiological change to platelets to improve performance. The improved performance prevents the overt symptoms.

FWIW, so when I read a new post on PDSA that is what I'm thinking when someone says they have or do not have symptoms when they are diagnosed. When there are no symptoms, counts have been low for awhile. On my ITP scale , rows 1 and 3 seem to be the most capable of developing slowly. LOL, so that is what I'd first guess what you are without any ITP treatment ever being administered.

Sometimes the difference between symptoms and no symptoms could be platelet microparticles. It could also be due to a person's actual platelet function or clotting abilities. There is so much to the clotting cascade and it is very complex. Platelets are not the only factor. A slow drop vs a fast drop is one factor, but there is more to it.

Interestingly, I had a root canal about 10 days ago and was prescribed the antibiotic Clindamycin-150mg by my dentist. I have never had problems with side effects, but this time I could not finish the recommended dosage before having sore and swollen throat, not to mention diarrhea. Additionally, had many bruises show up on arms. Will antibiotics cause platelet count to drop? I have not had it checked recently. Thanks for any feedback.

Yes, antibiotics can cause a platelet count to drop. Mine dropped twice years ago from Amoxicillin. Antibiotics can also cause a count to go up or it can stay the same. You never know, everyone is different.

I have had horrible side effects from antibiotics the past few years.

Thanx so much for your quick feedback. I will be getting count checked soon. Hopefully the antibiotic effects will wear off.

I had platelet count checked 5 days after going off antibiotic and count was 28 - about where it's been the last year and a half (I am not, nor have ever been, on any therapy). Additionally, there is no more major bruising, and the bruises I had (due to antibiotics?) are disappearing slowly. Contacting my hematologist, he said that yes, the antibiotic can result in the bruising.

I was also having dental issues and had taken amoxicillin a month before I was diagnosed. ITP it seems usually results when "something" fires up your immune system. There has been plenty of discussion on this board on a correlation or experience with antibiotics. When I take an inventory of all the things I was experiencing in the weeks prior to getting the rash and oral blisters it is no wonder my body went off kilter. I also have immature platelets that have just gotten to 7.0 MPV. The topic of platelet size leaves me confused. The last article I read was published in 1983 and stated that our marrow produces all sizes of platelets at random and that it is ITP and spleen that kills off the big ones and leaves the small ones and a low MPV. That seems to differ from many theories. I thought the study was quite profound as they took healthy patients blood, stained the platelets with a chromium dye, then returned it to the patient. Then they took blood a second time and found brand new fresh undyed platelets in all sizes in the same proportions as the dyed sample.

Wow - I've never read that platelets are produced in all sizes. I've always read that new ones (reticulated) are larger and shrink as they age.

The study isn't making much sense to me. All it seems to prove is that the first blood sample is similar to the second blood sample. It's an old article, newer ones are more credible.