Immature platelet fraction and bone marrow findings in hematology

Bone marrow examination (BME) and the assessment of the immature platelet fraction (IPF) are crucial diagnostic tools in hematology. The IPF is the proportion of young, newly released platelets of the total number in the peripheral circulation. We conducted a retrospective study of 1,552 patients with various hematologic disorders, evaluating the relationship between BME findings and IPF. Bone marrow aspirates and biopsies were assessed for their cellularity, the characteristics of the megakaryocytes, and the presence of dysplasia or malignant cells. The IPF was associated with BME findings and the final diagnoses made, and significantly correlated with the megakaryocyte count in patients with myelodysplastic syndrome (MDS), albeit weakly (R²=0.251, p < 0.001). Patients with immune thrombocytopenia exhibited much higher median IPFs (14.8% vs. 3.0%, respectively; p < 0.001) than those of other patients. Patients with MDS displayed wide variability in IPF (median: 6.8%, range: 0.40%-43.5%), and IPF demonstrated a high level of specificity for megakaryocyte abnormalities (p < 0.001). The study highlights the diagnostic utility of IPF in combination with BME, particularly for the differentiation of immune thrombocytopenia and the identification of megakaryocyte-related pathologies in MDS. Thus, the combined use of these two parameters could enhance diagnostic accuracy and inform treatment strategies for hematologic disorders.