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Thrombocytopenia is the second most common hematologic abnormality during pregnancy and is usually a benign condition. The challenge to the clinician is to weigh the risks of maternal and fetal bleeding complications against the benefits of diagnostic tests and interventions. This condition can also be associated with several diseases, either pregnancy specific or not, such as preeclampsia, HELLP syndrome, or idiopathic thrombocytopenic purpura (ITP). The differential diagnosis between ITP and gestational thrombocytopenia is clinically important with regard to the fetus, due to the risk of neonatal thrombocytopenia. The immature platelet fraction (IPF) is young cells that have recently been released into the circulation, and are considered indicators of bone marrow recovery. They contain a higher concentration of RNA than mature platelets. Measure of immature platelet fraction (IPF) has been suggested as a less invasive and early diagnostic test in the study of thrombocytopenic disorders. Immature platelet fraction can be currently measured by fully automated hematology analyzers providing clinical utility for diagnosing and monitoring thrombocytopenia.

Pregnant women with thrombocytopenia were selected (2015-2016); a total of 25 patients (mean age: 33 yrs, range 19-43 yrs) were examined with platelet count <100.000 platelets/μL. Venous whole-blood samples were collected into Vacutainer EDTA-K2E tubes (Becton Dickinson and Company, Plymouth, UK).

Complete blood counts and immature platelet fraction (%IPF) were immediately analyzed within 2 h of blood withdrawal by Sysmex XN20 system (Sysmex Corporation, Kobe, Japan). Novel PLT-F channel uses fluorescent light and stains platelets specifically with Oxazine Dye (Fluorescent Fluorocell). Bleeding complication has been collected in order to know if there is related to %IPF.

Mean platelet count was 73.000 platelets/μL (range of 69-91) and IPF mean was 11% (2,5-23,4). Lab test Hemoglobin shows a mean of 95,17 g/L [range of 45-132] ( in no-bleeding group was 105,8 g/L whereas in bleeding-group was 86,14 g/L p=0,0768) p=0,07. IPF% was <10% in 11, which means a 44% of the patients.

14 patients bleed during or after labor, 56% among all the patients in this study. Related to this group, 11 patients had IPF <10%; 3 of bleeding patients showed an IPF >10%. All pregnant women with an IPF < 10% (11/11) bleed as a complication. Pregnant women with thrombocytopenia and a IPF <10% has a higher risk of bleeding during and/or after labor compared with pregnant women with a IFP>10% (Fisher 12,41, P<0,001).

5 (20,83%) patients among all of them were under treatment (earlier or during labor): 3 (12,5%) with steroids and 2 (8,33%) with other methods.

Thrombocytopenia is a potential risk of bleeding during the labor. A high IPF indicates either consumptive or recovering thrombocytopenic disorders, such as immune thrombocytopenic purpura, while low IPF is characteristic of bone marrow suppression states. Although not directly used in clinical decision making, the reference range is critical to the introduction of new parameters and the interpretation of laboratory results. Our results suggest that IPF is an easy laboratory parameter to be measured and a level <10% might be an independent bleeding factor which can be useful for detecting high risk pregnant patients. It should be corroborated in further studies.